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Comparing the efficacy of catheter ablation strategies for persistent atrial fibrillation: a Bayesian analysis of randomized controlled trials

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Abstract

Background

Catheter ablation has been recommended as the first-line treatment option for selected patients with atrial fibrillation (AF). However, a widely accepted ablation strategy for persistent AF (perAF) has not yet been established. The benefits of ablation strategies are not conclusive for perAF. There is an urgent need to systematically analyze the results of previous studies and rank these treatment strategies to guide clinical practice.

Methods

Randomized controlled trials (RCTs) on ablation for perAF were included. The primary outcome was recurrence of atrial tachyarrhythmia (AT) after a single ablation procedure. A Bayesian random-effects network meta-analysis model was fitted.

Results

Twenty-three studies were included in the analysis. A total of 3394 patients and 22 ablation strategies were found in the involved studies. The ablation strategy of pulmonary vein isolation (PVI) + electrical box isolation of the left atrial posterior wall (PBOX) + non-PV trigger ablation (NPV) showed the best treatment effect in terms of the primary outcome. The individualized ablation strategies of mapping and ablation combined with PVI, such as PVI + rotors, PVI + dispersion areas, and PVI + low voltage zone (LVZ) also showed a better ablation effect in perAF.

Conclusions

PVI ablation is a widely used strategy in perAF and is recognized as a cornerstone procedure for perAF. The PVI + PBOX + NPV strategy showed the highest rank in our analysis. Mapping and ablation strategies that could provide individualized substrate modification also showed a better rank in our analysis and are believed to be a promising direction for the treatment of perAF.

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Funding

This study was sponsored by the Natural Science Foundation of Shandong Province of China [ZR2019PH036] and the Key Research and Development Plan of Jinan Shandong Province of China [201805056].

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Authors and Affiliations

  1. Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China

    Sijia Wu & Hongkai Li

  2. Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, 324 Jingwulu Jinan 250010, Jinan, Shandong Province, China

    Shaolei Yi

  3. Department of Cardiology, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, China

    Jianming Yao

  4. People’s Hospital of Shizhong District, Zaozhuang, China

    Xueming Chen

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  1. Sijia Wu
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Correspondence to Shaolei Yi.

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Sijia Wu, Hongkai Li, and Shaolei Yi are co-first authors.

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Wu, S., Li, H., Yi, S. et al. Comparing the efficacy of catheter ablation strategies for persistent atrial fibrillation: a Bayesian analysis of randomized controlled trials. J Interv Card Electrophysiol 66, 757–770 (2023). https://doi.org/10.1007/s10840-022-01246-5

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  • DOI: https://doi.org/10.1007/s10840-022-01246-5

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