Prophylactic pulmonary vein isolation during cavotricuspid isthmus ablation for atrial flutter: A meta‐analysis

Abstract

Background: Atrial arrhythmias (AA), including atrial fibrillation (AF), have been reported in patients after cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFL). Several studies have examined the effect of performing concomitant pulmonary vein isolation (PVI) with CTI on recurrent AA. These studies were analyzed to determine the overall effect of this approach on recurrent AA. Methods:PubMed and Google Scholar were searched for randomized trials comparing the incidence of AA after CTI versus CTI + PVI until June 2018. Only patients without prior history of AF were included in the recurrent AA analysis. All patients were included in the analyses of other clinical outcomes.Results: Four randomized control trials were included in the meta-analysis. In the recurrent AA analysis, a total of 314 patients were randomized in the studies (n = 158 CTI, n = 156 CTI + PVI). Freedom from AA at 1 year was significantly higher in the CTI + PVI group versus CTI alone (odds ratio [OR] 0.25 [0.14, 0.44] 95% confidence interval [CI], P < 0.00001). A total of 550 patients (n = 336 CTI, n = 214 CTI + PVI) were included in analyses for procedure time, fluoroscopy time, and complications rates. Procedure time and fluoroscopy time were significantly longer in the CTI + PVI group (mean difference [MD]: 103.31 min [ 94.40, 112.23] 95% CI, P < 0.00001) and (MD: 16.47 min [14.89,18.05] 95% CI, P < 0.00001), respectively. Total complications were statistically similar between groups. Conclusion:This meta-analysis shows addition of a prophylactic PVI during CTI ablation significantly reduces recurrent AA at 1 year without significantly increasing major complications. K E Y W O R D S atrial arrhythmias, atrial fibrillation, atrial fibrillation ablation, atrial flutter, atrial flutter ablation A comprehensive literature search was performed on clinicaltrials.gov, PubMed, Cochrane central registry, and Google Scholar using the

Prophylactic pulmonary vein isolation during cavotricuspid isthmus ablation and period of freedom from atrial arrhythmia: A meta‐analysis and TSA

“…We read with great interest a meta-analysis by Koerber and colleagues titled "Prophylactic Pulmonary Vein Isolation during Cavotricuspid Isthmus Ablation for Atrial Flutter: A Meta-Analysis." 1 We would like to congratulate the authors for this analysis. However, we had the following observation to make.…”

Prophylactic pulmonary vein isolation: One bridge too far?

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We have read with interest a recent metanalysis comparing pulmonary vein isolation (PVI) and cavo-tricuspid isthmus (CTI) ablation versus CTI ablation alone for the treatment of patients with typical atrial flutter (AFl) only. 1 We find this paper an opportunity for further discussion on PVI and CTI ablation.Bidirectional CTI block is a well-defined endpoint of ablation of AFl.Electrophysiological background of AFl is well determined. CTI ablation can be effectively and safely performed using simple and inexpensive tools, even in low-volume centers.

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“…We have read with interest a recent metanalysis comparing pulmonary vein isolation (PVI) and cavo‐tricuspid isthmus (CTI) ablation versus CTI ablation alone for the treatment of patients with typical atrial flutter (AFl) only . We find this paper an opportunity for further discussion on PVI and CTI ablation.…”

“…Koerber and colleagues showed the benefits of prophylactic PVI in addition to CTI for the treatment of AFl. This metanalysis, although scientifically important for further investigation of pathomechanisms of AF and AFl, may lead to unintentional promotion of performing PVI in patients undergoing typical AFl ablation.…”

Right atrial flutter as a marker of biatrial substrate for atrial fibrillation: Is more always better?

“…We read with great interest the article by Koerber and colleagues titled “Prophylactic Pulmonary Vein Isolation (PVI) during Cavotricuspid Isthmus (CTI) Ablation for Atrial Flutter (AFl): A Meta‐Analysis” about the importance of the prophylactic PVI during CTI ablation on long‐term atrial fibrillation (AF) recurrence without significantly increasing major complications. Despite the increased procedure and fluoroscopy times, there was no significant increase in major complications . We want to address some points that merit more attention and would like to hear author's opinions about the importance of prophylactic PVI in the current era of only symptomatic relive of AF ablation …”