Aims: Several techniques have been utilized for the ablation of persistent (P) and long-standing persistent (LsP) atrial fibrillation (AF); however, the best approach of substrate ablation remains poorly defined. This study aims to examine the impact of ablation approach on outcomes associated with P or LsP AF ablation by conducting a meta-analysis and regression on contemporary literature. Methods and results: A systematic literature review was conducted up to 29 July 2015 for scientific literature reporting on outcomes associated with P or LsP AF ablation. One hundred and thirteen studies reported outcomes in a total of 18 657 patients undergoing various ablation approaches for the treatment of P-LsP AF between 2001 and 2015. The point efficacy estimate of a single-AF ablation procedure without the use of anti-arrhythmic drugs was 43% (95% CI; 39-47%). Multiple procedures and/or the use of anti-arrhythmic drugs increase success to 69% (95% CI; 66-71%). Meta-regression revealed that ablation technique (P < 0.001) and left atrial size (P = 0.02) were predictive of single procedure, drug-free success. The addition of extra-pulmonary substrate approaches was associated with declining efficacy when compared to a pulmonary vein ablation alone. Conclusion: The efficacy of a single-AF ablation procedure for P or LsP AF is 43%; however, can be increased to 69% with the use of multiple procedures and/or anti-arrhythmic drugs. Current literature supports the finding that pulmonary vein antrum ablation/isolation is at least equivalently efficacious to other contemporary P-LsP ablation strategies.
Aims: Several techniques have been utilized for the ablation of persistent (P) and long-standing persistent (LsP) atrial fibrillation (AF); however, the best approach of substrate ablation remains poorly defined. This study aims to examine the impact of ablation approach on outcomes associated with P or LsP AF ablation by conducting a meta-analysis and regression on contemporary literature. Methods and results: A systematic literature review was conducted up to 29 July 2015 for scientific literature reporting on outcomes associated with P or LsP AF ablation. One hundred and thirteen studies reported outcomes in a total of 18 657 patients undergoing various ablation approaches for the treatment of P-LsP AF between 2001 and 2015. The point efficacy estimate of a single-AF ablation procedure without the use of anti-arrhythmic drugs was 43% (95% CI; 39-47%). Multiple procedures and/or the use of anti-arrhythmic drugs increase success to 69% (95% CI; 66-71%). Meta-regression revealed that ablation technique (P < 0.001) and left atrial size (P = 0.02) were predictive of single procedure, drug-free success. The addition of extra-pulmonary substrate approaches was associated with declining efficacy when compared to a pulmonary vein ablation alone. Conclusion: The efficacy of a single-AF ablation procedure for P or LsP AF is 43%; however, can be increased to 69% with the use of multiple procedures and/or anti-arrhythmic drugs. Current literature supports the finding that pulmonary vein antrum ablation/isolation is at least equivalently efficacious to other contemporary P-LsP ablation strategies.
Authors: Mahmood I Alhusseini; Firas Abuzaid; Albert J Rogers; Junaid A B Zaman; Tina Baykaner; Paul Clopton; Peter Bailis; Matei Zaharia; Paul J Wang; Wouter-Jan Rappel; Sanjiv M Narayan Journal: Circ Arrhythm Electrophysiol Date: 2020-07-06
Authors: George Leef; Fatemah Shenasa; Neal K Bhatia; Albert J Rogers; William Sauer; John M Miller; Mark Swerdlow; Mallika Tamboli; Mahmood I Alhusseini; Erin Armenia; Tina Baykaner; Johannes Brachmann; Mintu P Turakhia; Felipe Atienza; Wouter-Jan Rappel; Paul J Wang; Sanjiv M Narayan Journal: Circ Arrhythm Electrophysiol Date: 2019-07-29
Authors: Suvai Gunasekaran; Daniel C Lee; Bradley P Knight; Jeremy D Collins; Lexiaozi Fan; Amar Trivedi; Ann B Ragin; James C Carr; Rod S Passman; Daniel Kim Journal: Pacing Clin Electrophysiol Date: 2020-01-09 Impact factor: 1.976
Authors: Arunashis Sau; Sayed Al-Aidarous; James Howard; Joseph Shalhoub; Afzal Sohaib; Matthew Shun-Shin; Paul G Novak; Rick Leather; Laurence D Sterns; Christopher Lane; Prapa Kanagaratnam; Nicholas S Peters; Darrel P Francis; Markus B Sikkel Journal: Europace Date: 2019-08-01 Impact factor: 5.214