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Optimum lesion set and predictors of outcome in persistent atrial fibrillation ablation: a meta-regression analysis

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Title: Optimum lesion set and predictors of outcome in persistent atrial fibrillation ablation: a meta-regression analysis
Authors: Sau, A
Al-Aidarous, S
Howard, J
Shalhoub, J
Sohaib, A
Shun-Shin, M
Novak, PG
Leather, R
Sterns, LD
Lane, C
Kanagaratnam, P
Peters, NS
Francis, DP
Sikkel, MB
Item Type: Journal Article
Abstract: AIMS: Ablation of persistent atrial fibrillation (PsAF) has been performed by many techniques with varying success rates. This may be due to ablation techniques, patient demographics, comorbidities, and trial design. We conducted a meta-regression of studies of PsAF ablation to elucidate the factors affecting atrial fibrillation (AF) recurrence. METHODS AND RESULTS : Databases were searched for prospective studies of PsAF ablation. A meta-regression was performed. Fifty-eight studies (6767 patients) were included. Complex fractionated atrial electrogram (CFAE) ablation reduced freedom from AF by 8.9% [95% confidence interval (CI) -15 to -2.3, P = 0.009). Left atrial appendage [LAA isolation (three study arms)] increased freedom from AF by 39.5% (95% CI 9.1-78.4, P = 0.008). Posterior wall isolation (PWI) (eight study arms) increased freedom from AF by 19.4% (95% CI 3.3-38.1, P = 0.017). Linear ablation or ganglionated plexi ablation resulted in no significant effect on freedom from AF. More extensive ablation increased intraprocedural AF termination; however, intraprocedural AF termination was not associated with improved outcomes. Increased left atrial diameter was associated with a reduction in freedom from AF by 4% (95% CI -6.8% to -1.1%, P = 0.007) for every 1 mm increase in diameter. CONCLUSION : Linear ablation, PWI, and CFAE ablation improves intraprocedural AF termination, but such termination does not predict better long-term outcomes. Study arms including PWI or LAA isolation in the lesion set were associated with improved outcomes in terms of freedom from AF; however, further randomized trials are required before these can be routinely recommended. Left atrial size is the most important marker of AF chronicity influencing outcomes.
Issue Date: 1-Aug-2019
Date of Acceptance: 27-Mar-2019
URI: http://hdl.handle.net/10044/1/73948
DOI: https://dx.doi.org/10.1093/europace/euz108
ISSN: 1099-5129
Publisher: Oxford University Press (OUP)
Start Page: 1176
End Page: 1184
Journal / Book Title: Europace
Volume: 21
Issue: 8
Copyright Statement: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. This is a pre-copy-editing, author-produced version of an article accepted for publication in Europace following peer review. The definitive publisher-authenticated version is available online at: https://academic.oup.com/europace/article/21/8/1176/5487276
Sponsor/Funder: Wellcome Trust
British Heart Foundation
Rosetrees Trust
British Heart Foundation
British Heart Foundation
British Heart Foundation
British Heart Foundation
Imperial College Healthcare NHS Trust- BRC Funding
British Heart Foundation
Funder's Grant Number: PS3162_WHCP
RE/18/4/34215
A1173/ M577
RG/16/3/32175
RE/08/002/23906
PG/16/17/32069
PG/16/17/32069
RDB02
FS/14/27/30752
Keywords: Ablation
Lesion set
Meta-analysis
Outcome
Persistent atrial fibrillation
Ablation
Lesion set
Meta-analysis
Outcome
Persistent atrial fibrillation
1103 Clinical Sciences
Cardiovascular System & Hematology
Publication Status: Published
Conference Place: England
Online Publication Date: 2019-05-09
Appears in Collections:Department of Surgery and Cancer