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Efficacy and safety of low voltage area ablation for atrial fibrillation: a systematic review and meta-analysis

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Abstract

Background

Pulmonary vein isolation is the cornerstone of atrial fibrillation (AF) ablation. However, the recurrence rate of AF after pulmonary vein isolation (PVI) remains high. The efficacy and safety of low voltage area (LVA) ablation in the treatment of AF are uncertain.

Methods

The studies comparing the efficacy and safety of LVA ablation and LVA non-ablation for AF were systematically reviewed and meta-analyzed. Outcomes of interest included recurrent event, procedure time, and fluoroscopy time. Continuous variables were evaluated with mean deviation (MD) and standard mean difference (SMD). Odds ratio (OR) values and its 95% confidence intervals (CI) were used in meta-analysis of binary variables.

Results

Fourteen studies were eligible for inclusion. The AF recurrence was similar between the two groups, with no statistical difference (25.7% (67/346) vs. 28% (63/225), P = 0.49). LVA ablation did not increase the incidence of AT (8.7% (20/231) vs. 14.5% (28/193), P = 0.66). Fluoroscopy time was longer in the LVA ablation group (31.4 ± 8.4 min vs. 26.3 ± 7.8 min, P < 0.05). Complication rates were similar between the two groups (26.6% (17/64) vs. 21.7% (13/60), P = 0.53). Patients with LVA had higher AT/AF recurrence (32.9% (213/647) vs. 24.2% (229/948), P < 0.05).

Conclusions

Patients with left atrial LVA have a poor prognosis after catheter ablation. LVA ablation did not reduce the recurrence of AF nor did it increase the recurrence of atrial tachycardia.

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Acknowledgements

We acknowledge the support received from the project prevention of cardiogenic stroke and Strategies for training primary hospitals in Liaoning Province (Fund no.2019jh6/10400005).

Funding

This study was funded by the project prevention of cardiogenic stroke and Strategies for training primary hospitals in Liaoning Province (Fund no.2019jh6/10400005).

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Authors and Affiliations

  1. Department of Cardiology, The First Hospital of China Medical University, Nanjing North Street No. 155, Heping District, Shenyang, 110001, China

    He Jia, Wenyu Wang & Bo Yu

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  1. He Jia
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  2. Wenyu Wang
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Correspondence to Bo Yu.

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This study was approved by the ethics committee within the hospital and performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki.

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Jia, H., Wang, W. & Yu, B. Efficacy and safety of low voltage area ablation for atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol 66, 1519–1527 (2023). https://doi.org/10.1007/s10840-022-01258-1

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  • DOI: https://doi.org/10.1007/s10840-022-01258-1

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