Persistent atrial fibrillation: A systematic review and meta-analysis of invasive strategies

Abstract

Background: Persistent atrial fibrillation (AF) is associated with higher stroke and mortality risk than paroxysmal AF (pAF). Outcomes of catheter or surgical ablation are worse in patients with persistent AF than in pAF, and the optimal invasive rhythm control strategy has not been established. Purpose: We provide a contemporary systematic overview on efficacy and safety of catheter and minimallyinvasive surgical ablation for persistent AF. Methods: We systematically searched EMBASE, MEDLINE and CENTRAL from inception to July 2018 for randomized trials on surgical and catheter ablation, and included all study arms on persistent AF. Outcome was AF freedom after ≥12 months follow-up without AAD use. Random effects models were used to calculate proportions with 95%-confidence intervals. Safety consisted of adverse events during treatment and follow-up. Results: We included 6 studies on minimally-invasive surgical ablation and 56 on catheter ablation, involving 7624 patients with persistent AF. AF Freedom at 12 months was 69% (95%CI 64-74%) after surgical and 51% (95%CI 46-56%) after catheter ablation. More severe procedural adverse events occurred with surgery than with catheter ablation. Conclusions: In persistent AF patients, minimally-invasive surgical ablation is associated with more procedural complications, but higher AF freedom. As adverse events after surgical ablation appear more severe than in catheter ablation, a patient-tailored therapy choice is warranted.

RETRACTED: Safety of radiofrequency ablation for reducing inflammatory cytokine levels and the left atrial diameter in patients with atrial fibrillation

“…RFA is a commonly used minimally invasive interventional therapy strategy with high efficacy for patients with AF. 30 However, RFA also exposes patients to surgical risks owing to vascular puncture, catheter manipulation, and discharge for ablation. Besides being consistent with previous findings, our findings further confirm the safe application of RFA, despite known risks.…”

Acute breathlessness with frank hemoptysis following catheter ablation for atrial fibrillation, a cause not so obvious

“…This case of APT highlights the potential for acute presentations occurring within 24 hours of amiodarone administration in patients with previous uneventful exposure. It also highlights the diagnostic challenges following cardiac ablation due to the range of differential diagnoses including pulmonary vein stenosis, a rare but serious complication which occurs in approximately 0.3%‐0.8% . What is unusual in this case is the rapidity of onset of pulmonary toxicity, within 1‐2 doses.…”

Evaluation of stroke incidence with duty‐cycled multielectrode‐phased radiofrequency ablation of persistent atrial fibrillation results of the VICTORY AF Study

“…In a prospective evaluation of continuous warfarin therapy in stroke prevention after RF ablation, the COMPARE trial did not use clinical neurologists to assess patients as Victory AF did, and in the arm with uninterrupted VKA therapy reported a periprocedural stroke rate of 0% in patients with PersAF, and 0.49% in patients with long‐standing PersAF 11 . A large meta‐analysis of 56 catheter ablation studies, involving 7624 patients with persistent AF revealed a risk of thromboembolism of 0.7% 12 …”