Addition of catheter ablation strategies improve efficacy of pulmonary vein isolation in AF
Sweden: The efficacy of pulmonary vein isolation (PVI) alone can be increased by combining it with additional catheter ablation (CA) strategies, such as autonomic modulation and additional lines, a recent study in BMC Medicine has suggested.
Also, no differences in safety were observed implying that these strategies could be considered in treating patients with atrial fibrillation (AF). The study provides decision-makers with comprehensive and comparative evidence about the safety and efficacy of different CA strategies.
There is no consensus on the most efficient strategy of catheter ablation for atrial fibrillation patients. Emmanouil Charitakis, Linköping University, Linköping, Sweden, and colleagues aimed to compare the safety and efficacy of different CA strategies for AF ablation through network meta-analysis (NMA).
For this purpose, the researchers conducted a systematic search of online databases up to October 5th, 2020. It included randomized controlled trials (RCT) comparing different CA approaches. Efficacy was defined as recurrence of arrhythmia after CA and safety as any reported complication related to the procedure during a minimum follow-up time of 6 months.
A total of 67 RCTs (n = 9871) comparing 19 different CA strategies were included.
Key findings of the study include:
- The risk of recurrence was significantly decreased compared to pulmonary vein isolation alone for PVI with renal denervation (RR: 0.60), PVI with ganglia-plexi ablation (RR: 0.62), PVI with additional ablation lines (RR: 0.8), and PVI in combination with bi-atrial modification (RR: 0.32).
- Strategies including PVI appeared superior to non-PVI strategies such as electrogram-based approaches.
- No significant differences in safety were observed.
To conclude, the CA strategies described in the study could be considered to yield higher efficacy, without hampering safety. Additionally, CA seems to be superior to AADs apart from non-PVI strategies.
"This is the first study to provide decision-makers with robust, comprehensive, and comparative evidence about the safety and efficacy of different CA strategies that reflect the available evidence," the researchers wrote.
Reference:
Charitakis, E., Metelli, S., Karlsson, L.O. et al. Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: a network meta-analysis. BMC Med 20, 193 (2022). https://doi.org/10.1186/s12916-022-02385-2
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