Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation in Persistent AF

Mohanty, Sanghamitra; Mohanty, Prasant

doi:10.1001/jama.2023.5282

Cited by 2 publications

(3 citation statements)

References 5 publications

(12 reference statements)

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“…First, the sample size was calculated based on trials recruiting patients on and off antiarrhythmic drugs, 37,38 which is not consistent with the primary outcome, atrial arrhythmiafree survival off antiarrhythmic drugs. 39 Second, the high failure rate (68%) in CAPLA trial ablation technique, using comparable ablation power as previous studies, can imply failure of arrhythmogenic sources isolation. 39 Finally, the 1-year follow-up is not adequate for subtle conclusions on the technique's efficacy.…”

Section: Discussionmentioning

confidence: 74%

“…39 Second, the high failure rate (68%) in CAPLA trial ablation technique, using comparable ablation power as previous studies, can imply failure of arrhythmogenic sources isolation. 39 Finally, the 1-year follow-up is not adequate for subtle conclusions on the technique's efficacy. However, Kistler et al intend to report data over longer periods of follow-up in the near future.…”

Section: Discussionmentioning

confidence: 74%

“…However, Kistler et al intend to report data over longer periods of follow-up in the near future. 39 It is crucial to consider the population characteristics; Lim 2012's patient cohort was generally younger. Regarding population age: The younger age of the patient population in Lim 2012 could be a potential reason for the better outcomes they observed.…”

Section: Discussionmentioning

confidence: 99%

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Adjunctive left atrial posterior wall isolation for atrial fibrillation: An updated systematic review and meta‐analysis

Ibrahim,

Elaraby,

Almaadawy

et al. 2024

Pacing Clinical Electrophis

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ObjectivePosterior left atrial wall isolation (PWI) plus traditional pulmonary vein isolation (PVI) has been proposed as a promising intervention to decrease atrial fibrillation (AF) recurrence. We aim to investigate the efficacy and safety of adding PWI to the traditional PVI in patients with AF.MethodsA systematic review and meta‐analysis was conducted using synthesizing randomized controlled trials (RCTs) retrieved by systematically searching PubMed, Web of Science, SCOPUS, EMBASE, and Cochrane through June 14, 2023. We used Stata version 17 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI) (PROSPERO ID: CRD42023446227).ResultsWe included 11 RCTs with a total number of 1534 patients. Combined ablation with PWI + PVI was not associated with any significant difference over PVI only regarding the recurrence of clinical AF (RR: 0.86 with 95% CI [0.70–1.06]), all atrial arrhythmia (RR: 0.93 with 95% CI [0.82–1.07]), nonatrial fibrillation arrhythmia (RR: 1.22 with 95% CI [0.97–1.53]), early AF (RR: 0.89 with 95% CI [0.62–1.27]), and antiarrhythmic drugs at discharge (RR: 0.83 with 95% CI [0.67–1.04]). However, it was associated with increased total ablation duration (minutes) (MD: 12.58 with 95% CI [6.80–18.37]) and total procedure duration (minutes) (MD: 16.77 with 95% CI [9.63–23.91]), without any significant difference regarding adverse events (RR: 1.05 with 95% CI [0.63–1.74]).ConclusionWhile the pooled data from PWI + PVI using point‐by‐point radiofrequency did not suggest a benefit in the recurrence of various atrial arrhythmias compared to PVI alone, PWI+PVI using direct posterior wall ablation, especially with cryoballoon, demonstrated a significant reduction in recurrence of AF/atrial arrhythmias. Also, PWI + PVI significantly increased the ablation and total procedure durations.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Adjunctive left atrial posterior wall isolation for atrial fibrillation: An updated systematic review and meta‐analysis

Ibrahim,

Elaraby,

Almaadawy

et al. 2024

Pacing Clinical Electrophis

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Pulsed field ablation technology for pulmonary vein and left atrial posterior wall isolation in patients with persistent atrial fibrillation

Schiavone,

Solimene,

Moltrasio

et al. 2024

Cardiovasc electrophysiol

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IntroductionLimited data exist on pulsed‐field ablation (PFA) in patients with persistent atrial fibrillation (PeAF) undergoing left atrial posterior wall isolation (LAPWI).MethodsThe Advanced TecHnologies For SuccEssful AblatioN of AF in Clinical Practice (ATHENA) prospective registry included consecutive patients referred for PeAF catheter ablation at 9 Italian centers, treated with the FARAPULSETM‐PFA system. The primary efficacy and safety study endpoints were the acute LAPWI rate, freedom from arrhythmic recurrences and the incidence of major periprocedural complications. Patients undergoing pulmonary vein isolation (PVI) alone, PWI + LAPWI and redo procedures were compared.ResultsAmong 249 patients, 21.7% had long‐standing PeAF, 79.5% were male; mean age was 63 ± 9 years. LAPWI was performed in 57.6% of cases, with 15.3% being redo procedures. Median skin‐to‐skin times (PVI‐only 68 [60−90] vs. PVI + LAPWI 70 [59−88] mins) did not differ between groups. 45.8% LAPWI cases were approached with a 3D‐mapping system, and 37.3% with intracardiac echocardiography. LAPWI was achieved in all patients by means of PFA alone, in 88.8% cases at first pass. LAPWI was validated either by an Ultrahigh‐density mapping system or by recording electrical activity + pacing maneuvers. No major complications occurred, while 2.4% minor complications were detected. During a median follow‐up of 273 [191–379] days, 41 patients (16.5%) experienced an arrhythmic recurrence after the 90‐day blanking period, with a mean time to recurrence of 223 ± 100 days and no differences among ablation strategies.ConclusionLAPWI with PFA demonstrates feasibility, rapidity, and safety in real‐world practice, offering a viable alternative for PeAF patients. LAPWI is achievable even with a fluoroscopy‐only method and does not significantly extend overall procedural times.

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Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation in Persistent AF

Cited by 2 publications

References 5 publications

Adjunctive left atrial posterior wall isolation for atrial fibrillation: An updated systematic review and meta‐analysis

Adjunctive left atrial posterior wall isolation for atrial fibrillation: An updated systematic review and meta‐analysis

Pulsed field ablation technology for pulmonary vein and left atrial posterior wall isolation in patients with persistent atrial fibrillation

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