Comparative Efficacy and Procedural Durability of Radiofrequency Ablation for Atrial Fibrillation: A Systematic Review and a Meta-Analysis
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Objectives: In patients with atrial fibrillation (AF), the success rate of pulmonary vein isolation procedure has improved with advances in three-dimensional mapping systems but procedure re- mains complex and time-consuming. AF ablation using a multielectrode catheters enabling both mapping and ablation have been developed to address the technical difficulties. Our objective was to systematically review current knowledge on the efficacy and procedural durability of AF ablation using a multielectrode catheter (MEA), compared to conventional pulmonary vein isolation (CPVI). Methods: We systematically searched PubMed, EMBASE, Cochrane, and Korean domestic databas- es for studies on MEA and CPVI. Results: Our meta-analysis showed that procedural time [stan- dardized mean difference (SMD)=-1.17, 95% confidence interval (CI): -1.67, -0.67] and fluoroscopic time (SMD=-0.64, 95% CI: -1.04, -0.24) were significantly shorter in MEA. The risk of AF recurrence [relative risk (RR)=0.85, 95% CI: 0.76, 0.94] was significantly lower and repeat procedures (RR=0.73, 95% CI: 0.53, 1.00) tended to be lower in MEA without statistical significance. No significant be- tween-treatment difference in complication rates was evident with a trend toward higher complica- tion rate in MEA (RR=1.04, 95% CI: 0.55, 1.93). Conclusion: In patients undergoing catheter abla- tion to treat AF, the efficacies of MEA and CPVI were comparable in terms of acute procedural success and repeat procedures. However, MEA afforded the benefit of reduced procedure-related time, including procedural time, fluoroscopic time, and radiofrequency application time and lower AF recurrence. MEA was associated with a slightly higher risk of thromboembolism, but nonethe- less afforded patient benefits, when skilled physicians carefully performed all procedures.
Abstract
Objectives: In patients with atrial fibrillation (AF), the success rate of pulmonary vein isolation procedure has improved with advances in three-dimensional mapping systems but procedure re- mains complex and time-consuming. AF ablation using a multielectrode catheters enabling both mapping and ablation have been developed to address the technical difficulties. Our objective was to systematically review current knowledge on the efficacy and procedural durability of AF ablation using a multielectrode catheter (MEA), compared to conventional pulmonary vein isolation (CPVI). Methods: We systematically searched PubMed, EMBASE, Cochrane, and Korean domestic databas- es for studies on MEA and CPVI. Results: Our meta-analysis showed that procedural time [stan- dardized mean difference (SMD)=-1.17, 95% confidence interval (CI): -1.67, -0.67] and fluoroscopic time (SMD=-0.64, 95% CI: -1.04, -0.24) were significantly shorter in MEA. The risk of AF recurrence [relative risk (RR)=0.85, 95% CI: 0.76, 0.94] was significantly lower and repeat procedures (RR=0.73, 95% CI: 0.53, 1.00) tended to be lower in MEA without statistical significance. No significant be- tween-treatment difference in complication rates was evident with a trend toward higher complica- tion rate in MEA (RR=1.04, 95% CI: 0.55, 1.93). Conclusion: In patients undergoing catheter abla- tion to treat AF, the efficacies of MEA and CPVI were comparable in terms of acute procedural success and repeat procedures. However, MEA afforded the benefit of reduced procedure-related time, including procedural time, fluoroscopic time, and radiofrequency application time and lower AF recurrence. MEA was associated with a slightly higher risk of thromboembolism, but nonethe- less afforded patient benefits, when skilled physicians carefully performed all procedures.
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