Is there still a role for additional linear ablation in addition to pulmonary vein isolation in patients with paroxysmal atrial fibrillation? An Updated Meta-analysis of randomized controlled trials. (15th April 2016)

• Record Type: Journal Article
• Authors: Hu, Xiaoliang; Jiang, Jingzhou; Ma, Yuedong; Tang, Anli
• Is Part Of: International journal of cardiology. Volume 209(2016)
• Page Start: 266
• Page End: 274
• Publication Date: 2016-04-15
• Subjects: Atrial fibrillation -- Catheter ablation -- Linear ablation -- Meta-analysis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.02.076
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The benefits and risks of additional left atrium (LA) linear ablation in patients with paroxysmal atrial fibrillation (AF) remain unclear. Methods: Randomized controlled trials were identified in the PubMed, Web of Science, Embase and Cochrane databases, and the relevant papers were examined. Pooled relative risks (RR) and 95% confidence interval (95% CI) were estimated using random effects models. The primary endpoint was the maintenance of sinus rhythm after a single ablation. Results: Nine randomized controlled trials involving 1138 patients were included in this analysis. Additional LA linear ablation did not improve the maintenance of the sinus rhythm following a single procedure (RR, 1.03; 95% CI, 0.93–1.13; P = 0.60). A subgroup analysis demonstrated that all methods of additional linear ablation failed to improve the outcome. Additional linear ablation significantly increased the mean procedural time (166.53 ± 67.7 vs. 139.57 ± 62.44 min, P < 0.001), the mean fluoroscopy time (54.56 ± 38.7 vs. 44.32 ± 31.6 min, P < 0.001) and the mean radiofrequency (RF) energy application time (78.94 ± 28.39 vs. 59.74 ± 22.38 min, P < 0.001). No statistically significant differences in the rates of complications were noted (RR, 0.57; 95% CI, 0.27–1.19; P = 0.13). Conclusions: Additional LA linear ablation did not exhibit any benefits in terms of sinus rhythm maintenance for paroxysmal AF patients following a single procedure. Additional linear ablation significantly increased the mean procedural, fluoroscopy and RF application times. This additional ablation was not associated with a statistically significant increase in complication rates. This finding must be confirmed by further large, high-quality clinical trials.