Long-Term Effect Of Different Radiofrequency Catheter Ablation Techniques On Atrial Fibrillation

Background:This meta-analysis was performed to assess the long-term efficacy and safety of the five kinds of ablation approaches on atrial fibrillation (AF) patients after more than one single procedure with or without antiarrhythmic drugs (AADs).Methods and Results:A systemic literature search in the Cochrane Library, MEDLINE and EMBASE was performed to assemble the controlled cohort studies comparing CPVI (circumferential pulmonary vein isolation) and SPVI (segmental pulmonary vein isolation), PVAI (pulmonary vein antrum isolation) and PVAI+CFAE/GP (Complex fractionated atrial electrograms/Ganglion plexus) ablation as well as PVI (pulmonary vein isolation) and CFAE/GP ablation.2163cases in22trials were included in the meta-analysis. The effect of CPVI was compared with SPVI in8trials, suggesting a higher proportion of maintenance of sinus rhythm in CPVI (RR1.16;95%CI:1.04-1.30). The effect of PVAI+CFAE/GP ablation were evaluated in9trials compared with PVAI, showing adjunctive CFAE/GP ablation had a significant long-term effect on sinus rhythm maintenance (RR1.17;95%CI:1.03-1.32) in non-paroxysmal AF but not in paroxysmal AF (RR1.13;95%CI:0.95-1.35). Then, the long-term effect of CFAE/GP ablation was not superior to PVI (RR1.49;95%CI:1.09-2.04) according to selected7trials for the obvious heterogeneity. Conclusions:This study suggested that the long term efficacy of different radiofrequency were78.8%. SPVI was significantly inferior to CPVI. Adjunctive CFAE/GP ablation significantly increased the freedom from AF in non-paroxysmal AF but not in paroxysmal AF, however when compared alone, the benefits of CFAE/GP ablation was not superior to PVI.