Corresponding author:
Mishal Mumtaz, MBBS.
Quaid-e-Azam Medical College Bahawalpur, affiliated with University of
Health Sciences Lahore, Pakistan.
Mishal_mumtaz@hotmail.com
Total Word Count: 4095 (including references)
Background: Pulmonary vein isolation (PVI) has evolved to be an
integral part of ablative therapy for atrial fibrillation (AF), however,
recurrence rates of AF remain high even after complete wide area
circumferential PVI. In recent years adjunct posterior wall isolation
(PWI) has been performed in patients with more persistent forms of AF
but the benefits remain unclear.
Aim: The objective of this meta-analysis was to evaluate the
efficacy of adjunct posterior wall isolation in reducing recurrence rate
of AF using cryoballoon ablation (CBA).
Methods: We searched PubMed, Google Scholar, Clinicaltrials.gov
and Cochrane CENTRAL. We included studies comparing PVI to PVI + PWI in
patients with persistent AF undergoing CBA. After data extraction and
quality assessment of the studies, we assessed recurrence rates of
atrial tachy-arrhythmias (AF, atrial flutter, and atrial tachycardia) as
well as total ablation time and procedural adverse events. Risk ratio
(RR), mean difference (MD) and 95% confidence interval (CI) were
calculated using Review Manager.
Results: Concomitant PWI demonstrated significant decrease in
recurrence risk of AF (RR 0.48; 95% CI 0.36-0.64; p <
0.00001) as well as all atrial arrhythmias (RR 0.57; 95% CI 0.47-0.70;
p < 0.0001). There was no significant difference in adverse
events between both groups (RR 1.05; 95% CI 0.43-2.56; p = 0.91),
whereas total ablation time was significantly increased in PVI + PWI
group (MD 22.67, 95% CI, 7.61-37.73, p = 0.003).
Conclusion: Adjunct PWI when compared to PVI alone decreases
recurrence rates of atrial tachy-arrhythmias after CBA of persistent AF.