Adjunct posterior wall isolation reduces the recurrence of atrial fibrillation in patients undergoing cryoballoon ablation: A systematic review and meta‐analysis
Mishal Mumtaz, Sidra Jabeen, Ahmad Danial, Muhammad Tayyab Muzaffar Chaychi, Muhammad Kashan Zaheer, Aymen Mumtaz, Tayebah Mumtaz, Bengt Herweg- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Abstract
Background
Recurrence rates of atrial fibrillation (AF) remain high even after complete wide area circumferential pulmonary vein isolation (PVI). In recent years adjunct posterior wall isolation (PWI) has been performed in patients with more persistent forms of AF but the benefits remain unclear.
Aim
The objective of this meta‐analysis was to evaluate the efficacy of adjunct posterior wall isolation in reducing recurrence rates of AF using cryoballoon ablation (CBA).
Methods
We searched PubMed, Google Scholar,
Results
Concomitant PWI exhibited a substantial reduction in the risk of AF recurrence (RR: 0.51; 95% CI: 0.42–0.63, p < .00001), as well as all atrial arrhythmias (RR: 0.58; 95% CI: 0.49–0.68, p < .00001). On subgroup analysis, in patients with only PAF, adjunct PWI resulted in significant reduction in recurrence risk of AF (RR: 0.56; 95% CI: 0.41–0.76, p = .0002) as well. There was no significant difference in adverse events between both groups (RR: 0.90; 95% CI: 0.44–1.86; p = .78), whereas total ablation time was significantly increased in PVI + PWI group (MD: 21.75; 95% CI: 11.13–32.37, p < .0001).
Conclusion
Adjunct PWI when compared to PVI alone decreases recurrence rates of atrial fibrillation after CBA of patients with persistent as well as paroxysmal atrial fibrillation.