Pulmonary vein isolation and linear lesions in atrial fibrillation ablation

Abstract

The addition of linear lesions to PV isolation more effectively achieved sinus rhythm initially and fewer patients required additional management to maintain their rhythm when compared to patients who underwent lone PV isolation. However, at 9 months, the overall results were similar in both groups.

Approach to the Catheter Ablation Technique of Paroxysmal and Persistent Atrial Fibrillation: A Meta-Analysis of the Randomized Controlled Trials

“…There were 8 studies that examined the effect of adding either the roof line, the mitral isthmus line or both to PVI (with or without isolation) in paroxysmal AF 28–35 . Three of these also included persistent AF, 28,29,33 and an additional study included only persistent AF 36 .…”

“…When multiple procedures are taken into account using this technique, 24,29,30,34–36,38 the heterogeneity among the trials makes conclusions regarding the addition of linear lesions difficult. (See the Appendix in Supporting Information.…”

“…There were 8 studies that examined the effect of adding either the roof line, the mitral isthmus line or both to PVI (with or without isolation) in paroxysmal AF. [28][29][30][31][32][33][34][35] Three of these also included persistent AF, 28,29,33 and an additional study included only persistent AF. 36 Haissaguerre et al studied the addition of a mitral isthmus and CTI line, 7 Hocini et al studied the addition of a roof and CTI line, 8 and Oral et al studied the addition of linear lesions in the roof and MI, as well as additional ablation in areas of fractionation, if AF remained inducible.…”

“…37 Mikhaylov et al found no significant difference between the 2 groups after a single ablation (RR 21.14; 95% CI 0.53, 2.44) or multiple ablations (RR 2.13; 95% CI 0.52, 8.76). When multiple procedures are taken into account using this technique, 24,29,30,[34][35][36]38 the heterogeneity among the trials makes conclusions regarding the addition of linear lesions difficult. (See the Appendix in Supporting Information.)…”

Meta-analysis of the therapeutic effects of various methods for the treatment of chronic atrial fibrillation

“…There were four papers (23–26) in which the success rates of PVI and PVI + LAA in the treatment of chronic AF were compared. These papers included a total of 322 patients, with PVI + LAA as the test group and PVI as the control group (Table VI).…”