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.