Introduction
Atrial Fibrillation (AF) is on a rising trend worldwide with almost 37.6
million cases in 2017.(1) Health complications due to AF, including
ischemic stroke and heart failure, contribute significantly to morbidity
and mortality. (2) The primary goal in the management of patients with
AF is improvement of symptoms and the prevention of stroke and
cardiomyopathy. (3) In recent years management of AF has shifted from
pharmacologic rate and/or rhythm control to catheter ablation of AF (4)
yielding superior rhythm control when compared to antiarrhythmic
therapy. (5, 6)
Pulmonary vein isolation (PVI) is the cornerstone of current ablation
techniques for AF. Recurrences of atrial tachy-arrhythmias after AF
ablation procedure are more frequent in patients with persistent AF (7),
impact quality of life, and result in repeat ablation in 20 to 40% of
patients (8). Adjunctive ablation strategies targeting arrhythmia
substrates outside of the pulmonary veins (9) such as ablation of
complex fragmented electrograms, posterior wall ablation with
radiofrequency energy, (10) left atrial linear ablation and scar
modification have failed to demonstrate incremental benefit in
randomized controlled clinical trials.
The objective of this meta-analysis was to evaluate the efficacy of
adjunct posterior wall isolation in reducing recurrence rates of atrial
tachy-arrhythmias using cryoballoon ablation (CBA) in patients with
persistent AF.