Pablo B Nery1, Daniel Belliveau2, Girish M Nair2, Jordan Bernick3, Calum J Redpath2, Agnieszka Szczotka4, Mouhannad M Sadek2, Martin S Green2, George Wells3, David H Birnie2. 1. Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: PNery@ottawaheart.ca. 2. Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 3. Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 4. Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Abstract
OBJECTIVES: This study systematically reviewed the prevalence of pulmonary vein (PV) reconnection in subjects with and without AF recurrence and assessed the relationship between PV reconnection and freedom from atrial fibrillation (AF). BACKGROUND: Pulmonary vein reconnection is frequently observed in patients experiencing recurrent AF post catheter ablation. However, its prevalence in AF-free patients has not been well studied. METHODS: An electronic search was performed for studies describing PV electrical conduction in subjects with and without AF recurrence post PV isolation (PVI). RESULTS: Eleven of 5,665 articles met selection criteria. A total of 683 subjects were included in the meta-analysis; 379 had AF recurrence, and 304 were AF-free. Among patients with AF recurrence, 324 of 379 patients (85.5%) had at least 1 pulmonary vein reconnected. Among AF-free patients, 178 of 304 patients (58.6%) had at least 1 PV electrically reconnected, and 126 of 304 (41.4%) had durable PVI. The relative risk (RR) of recurrent AF was significantly lower with durable PVI than with PV reconnection (RR: 0.57; 95% confidence interval [CI]: 0.37 to 0.86; p = 0.008). Analysis of 7 studies including exclusively paroxysmal AF patients (n = 470) showed RR of 0.69 (95% CI: 0.45 to 1.05; p = 0.09). CONCLUSIONS: This meta-analysis shows that durable PVI is associated with a lower risk of AF recurrence after catheter ablation. However, the association was modest, and PV electrical reconnection is common, affecting 58% of AF-free patients. Analysis of studies that included exclusively patients with paroxysmal AF showed a weaker relationship. Additional research is warranted to better understand the mechanism(s) of benefit of catheter ablation for AF and investigate whether PVI should be the primary goal.
OBJECTIVES: This study systematically reviewed the prevalence of pulmonary vein (PV) reconnection in subjects with and without AF recurrence and assessed the relationship between PV reconnection and freedom from atrial fibrillation (AF). BACKGROUND:Pulmonary vein reconnection is frequently observed in patients experiencing recurrent AF post catheter ablation. However, its prevalence in AF-freepatients has not been well studied. METHODS: An electronic search was performed for studies describing PV electrical conduction in subjects with and without AF recurrence post PV isolation (PVI). RESULTS: Eleven of 5,665 articles met selection criteria. A total of 683 subjects were included in the meta-analysis; 379 had AF recurrence, and 304 were AF-free. Among patients with AF recurrence, 324 of 379 patients (85.5%) had at least 1 pulmonary vein reconnected. Among AF-freepatients, 178 of 304 patients (58.6%) had at least 1 PV electrically reconnected, and 126 of 304 (41.4%) had durable PVI. The relative risk (RR) of recurrent AF was significantly lower with durable PVI than with PV reconnection (RR: 0.57; 95% confidence interval [CI]: 0.37 to 0.86; p = 0.008). Analysis of 7 studies including exclusively paroxysmal AFpatients (n = 470) showed RR of 0.69 (95% CI: 0.45 to 1.05; p = 0.09). CONCLUSIONS: This meta-analysis shows that durable PVI is associated with a lower risk of AF recurrence after catheter ablation. However, the association was modest, and PV electrical reconnection is common, affecting 58% of AF-freepatients. Analysis of studies that included exclusively patients with paroxysmal AF showed a weaker relationship. Additional research is warranted to better understand the mechanism(s) of benefit of catheter ablation for AF and investigate whether PVI should be the primary goal.
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