期刊
CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY
卷 12, 期 8, 页码 -出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCEP.118.007005
关键词
atrial fibrillation; catheter ablation; esophageal fistula; meta-analysis; posterior left atrium; pulmonary vein
资金
- Australian Postgraduate Award Scholarship from the University of Adelaide
- Robert J. Craig Lectureship from the University of Adelaide
- Jitendra K. Vohra Electrophysiology Scholarship from the University of Adelaide
- Beacon Research Fellowship from the University of Adelaide
- Asia Pacific Heart Rhythm Society
- New Zealand Heart Foundation overseas fellowship scholarship
- Indonesia Endowment Fund for Education, Ministry of Finance, The Republic of Indonesia
- Robert J. Craig Postgraduate Scholarship from the University of Adelaide
- National Heart Foundation of Australia
- Leo J. Mahar Lectureship by the University of Adelaide
- National Health and Medical Research Council of Australia
- Leo J. Mahar Postgraduate Scholarship from the University of Adelaide
Background: The posterior left atrium is an arrhythmogenic substrate that contributes to the initiation and maintenance of atrial fibrillation (AF); however, the feasibility, safety, and efficacy of posterior wall isolation (PWI) as an AF ablation strategy has not been widely reported. Methods: We undertook a systematic review and meta-analysis of studies performing PWI to assess (1) acute procedural success including the ability to achieve PWI and the number of procedure-related complications, (2) Long-term, clinical success including rates of arrhythmia recurrence and posterior wall reconnection, and (3) The efficacy of PWI compared with pulmonary vein isolation on preventing arrhythmia recurrence. MEDLINE, EMBASE, and Web of Science databases were searched in May 2018 to retrieve relevant studies. Results were pooled using a random effects model. Results: Seventeen studies (13 box isolation, 3 single ring isolation, and 1 debulking ablation) comprising 1643 patients (31.3% paroxysmal AF, left atrial diameter 41 +/- 3.1 mm) were included in the final analysis. In studies focusing specifically on PWI, the acute procedural success rate for achieving PWI was 94.1% (95% CI, 87.2%-99.3%). Single-procedure 12-month freedom from atrial arrhythmia was 65.3% (95% CI, 57.7%-73.9%) overall and 61.9% (54.2%-70.8%) for persistent AF. Randomized control trials comparing PWI to pulmonary vein isolation (3 studies, 444 patients) yielded conflicting results and could not confirm an incremental benefit to PWI. Fifteen major complications (0.1%), including 2 atrio-esophageal fistulas, were reported. Conclusions: PWI as an end point of AF ablation can be achieved in a large proportion of cases with good rates of 12-month freedom from atrial arrhythmia. Although the procedure-related complication rate is low, it did not eliminate the risk of atrio-esophageal fistula. Registration: URL: . PROSPERO registration number: CRD42018107212.
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