Low-voltage area substrate modification for atrial fibrillation ablation: a systematic review and meta-analysis of clinical trials

医学 心房颤动 荟萃分析 置信区间 烧蚀 相对风险 导管消融 内科学 随机对照试验 心脏病学 肺静脉
作者
Joey Junarta,Muhammad Umer Siddiqui,Joshua M. Riley,Sean Dikdan,Akash Patel,Daniel R. Frisch
出处
期刊:Europace [Oxford University Press]
卷期号:24 (10): 1585-1598 被引量:46
标识
DOI:10.1093/europace/euac089
摘要

Abstract Aims The value of additional ablation beyond pulmonary vein isolation for atrial fibrillation (AF) ablation is unclear, especially for persistent AF. The optimal target for substrate modification to improve outcomes is uncertain. We investigate the utility of low-voltage area (LVA) substrate modification in patients undergoing catheter ablation for AF. Methods and results This meta-analysis was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Medline, Scopus and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Risk of bias was assessed using the Cochrane risk of bias tool. Only randomized studies were included. AF patients who underwent catheter ablation with voltage-guided substrate modification targeting LVA (LVA group) vs. conventional ablation approaches not targeting LVA (non-LVA group) were compared. Four studies comprising 539 patients were included (36% female). Freedom from arrhythmia (FFA) in patients with persistent AF was greater in the LVA group [risk ratio (RR) 1.30; 95% confidence interval (CI) 1.03–1.64]. There was no difference in FFA in patients with paroxysmal AF between groups (RR 1.30; 95% CI 0.89–1.91). There was no difference in total procedural time (mean difference −17.54 min; 95% CI −64.37 to 29.28 min) or total ablation time (mean difference −36.17 min; 95% CI −93.69 to 21.35 min) in all included patients regardless of AF type between groups. There was no difference in periprocedural complications between groups in all included patients regardless of AF type (RR 0.93; 95% CI 0.22–3.82). Conclusion This meta-analysis demonstrates improved FFA in persistent AF patients who underwent voltage-guided substrate modification targeting LVA.
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