The Short and Long-Term Efficacy of Pulmonary Vein Isolation as a Sole Treatment Strategy for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis

Abstract

Background:Pulmonary vein isolation (PVI) is an accepted treatment strategy for catheter ablation (CA) of paroxysmal atrial fibrillation (PAF). In this study, we aimed to assess the short, mid- and long-term outcome of PVI as a sole treatment strategy for PAF.Methods:Six bibliographic electronic databases were searched to identify all published relevant stud-ies until December 14, 2015. Search of the scientific literature was performed for studies describing outcomes with mean follow-up > 24 months after PAF ablation. Only articles with 1, 3 or 5-year fol-low up were included, from the same group of investigators.Results:Of the 2398 references reviewed for eligibility, 13 articles (enrolling a total of 1774 patients) were included in the final analysis. Pooled analysis showed that the 12- and 62 -month success rate of a single CA procedure was 78% (95% CI 0.76% to 0.855) and 59% (95% CI 0.56% to 0.64%), re-spectively. The results did not differ by type of CA performed. Major complications mentioned in the enrolled studies were cerebrovascular event, pericardial tamponade and PV stenosis.Conclusion:There is a progressive and significant decline in freedom from AF between 1, 3 and 5-year after successful PVI in patients with PAF. Our analysis suggests that a high short-time success rate after PVI does not necessarily result in high chronic success rate.

Atrial Fibrillation Mechanisms and Implications for Catheter Ablation

“…PVI is associated with high rates of freedom from AF recurrence. The freedom rate from AF recurrence varies between 60 and 79% (Katritsis et al, 2008 ; Takigawa et al, 2015a ; Straube et al, 2016 ; Kis et al, 2017 ), 60 and 72% at 3 years (Vogt et al, 2013 ; Takigawa et al, 2015a ; Takarada et al, 2017 ) and decreases to 53–68% at 5 years (Neumann et al, 2013 ; Takigawa et al, 2015a , 2017 ; Kis et al, 2017 ). The long term freedom from AF may reach 77% (Vogt et al, 2013 ) after redo PVI.…”

Symptomatic and silent atrial fibrillation recurrences after PVI ablation – usefulness of prolonged 7-day Holter recordings. One-center observation

“…Some of our patients were qualified for the next ablation, but it was not our point of interest in this study. Moreover, no data on silent AF were given by Scherr et al A meta-analysis of 13 different studies (1774 patients) [6] showed that the 12-month success rate of a single ablation procedure was 78%. However, different types of ablation procedures were used in these studies, and there were data on silent AF as well.…”

Percutaneous versus thoracoscopic ablation of symptomatic paroxysmal atrial fibrillation: a randomised controlled trial - the FAST II study

“…In a review article by Kis et al on CA PVI treatment [ 14 ] showed a success rate of 78% (freedom from AF both on and off AADs) based on the majority of the included studies having 24-h Holter monitoring at different time intervals as a reflection of success. In our opinion, this would generally be insufficient to detect asymptomatic episodes of AF.…”