Academic Journal
Left atrial posterior wall isolation in addition to pulmonary vein isolation using a pentaspline catheter in pulsed-field ablation for atrial fibrillation: A systematic review and meta-analysis
| Title: | Left atrial posterior wall isolation in addition to pulmonary vein isolation using a pentaspline catheter in pulsed-field ablation for atrial fibrillation: A systematic review and meta-analysis |
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| Authors: | Raymond Pranata, MD, William Kamarullah, MD, Giky Karwiky, MD, Chaerul Achmad, MD, PhD, Mohammad Iqbal, MD, PhD |
| Source: | Heart Rhythm O2, Vol 5, Iss 10, Pp 720-727 (2024) |
| Publisher Information: | Elsevier, 2024. |
| Publication Year: | 2024 |
| Collection: | LCC:Diseases of the circulatory (Cardiovascular) system |
| Subject Terms: | Ablation, Pulsed-field ablation, Atrial fibrillation, Left atrial posterior wall isolation, Pulmonary vein isolation, Additional ablation, Diseases of the circulatory (Cardiovascular) system, RC666-701 |
| More Details: | Background: Persistent atrial fibrillation (AF) may require extensive ablation strategies. Left atrial posterior wall isolation (LAPWI) might address potential substrates for recurrence during pulsed-field ablation (PFA). Objective: This meta-analysis aimed to investigate the feasibility and effectiveness of LAPWI in addition to pulmonary vein isolation (PVI) using a pentaspline catheter in PFA for AF. Methods: Comprehensive search was conducted using PubMed, SCOPUS, ScienceDirect, and EuropePMC for studies reporting LAPWI+PVI using a pentaspline catheter in PFA ablation for AF. The primary outcome was atrial tachyarrhythmia (ATa) recurrence, defined as AF/atrial flutter/atrial tachycardia after blanking period. Results: There were 882 patients from 7 studies. The success rate of LAPWI was 100% using mean/median of 16 to 20 added PFA applications with no reported acute left atrial posterior wall reconnection and esophageal complications. In mean follow-up of 240 ± 91 days, ATa recurrence was 21% (95% CI 13%–29%; I2 = 84.8%) in the LAPWI+PVI group. Meta-regression analysis showed that age, left ventricular ejection fraction, and repeat procedure did not significantly influence ATa recurrence (P > .05). Each 1-mm increase in left atrial diameter, increases the chance of ATa recurrence by 6% (R2 = 100%, P < .001, I2 = 0%). Meta-analysis showed no difference in terms of ATa recurrence among LAPWI+PVI patients compared with those without LAPWI (odds ratio 0.78, 95% confidence interval 0.50–1.21, P = .27; I2 = 0%, P = .86). Procedure time and fluoroscopy time did not significantly differ (P > .05). Conclusion: LAPWI using a pentaspline catheter during PFA was feasible and did not prolong the procedure/fluoroscopy but did not reduce ATa recurrence. LAPWI may be considered during PFA, although the benefit is uncertain. |
| Document Type: | article |
| File Description: | electronic resource |
| Language: | English |
| ISSN: | 2666-5018 |
| Relation: | http://www.sciencedirect.com/science/article/pii/S2666501824002654; https://doaj.org/toc/2666-5018 |
| DOI: | 10.1016/j.hroo.2024.08.006 |
| Access URL: | https://doaj.org/article/f8edcaec57bd4b809b06ac13f2db9dc1 |
| Accession Number: | edsdoj.f8edcaec57bd4b809b06ac13f2db9dc1 |
| Database: | Directory of Open Access Journals |
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