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Pulmonary vein isolation plus adjunctive therapy for the treatment of atrial fibrillation: a systematic review and meta-analysis

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Abstract

Background

Pulmonary vein isolation (PVI) is the primary technique for ablation of atrial fibrillation (AF). It is unclear whether adjunctive therapies in addition to PVI can reduce atrial arrhythmia recurrence (AAR) compared to PVI alone in patients with AF.

Methods

A meta-analysis of randomized controlled trials comparing PVI plus an adjunctive therapy (autonomic modulation, linear ablation, non-pulmonary vein trigger ablation, epicardial PVI [hybrid ablation], or left atrial substrate modification) to PVI alone was conducted. The primary outcome was AAR. Cumulative odd’s ratios (OR) and 95% confidence intervals (CI) were calculated for each treatment type.

Results

Forty-six trials were identified that included 8,500 participants. The mean age (± standard deviation) was 60.2 (±4.1) years, and 27.2% of all patients were female. The mean follow-up time was 14.6 months. PVI plus autonomic modulation and PVI plus hybrid ablation were associated with a relative 53.1% (OR 0.47; 95% CI 0.32 to 0.69; p < 0.001) and 59.1% (OR 0.41; 95% CI 0.23 to 0.75; p = 0.003) reduction in AAR, respectively, compared to PVI alone. All categories had at least moderate interstudy heterogeneity except for hybrid ablation.

Conclusion

Adjunctive autonomic modulation and epicardial PVI may improve the effectiveness of PVI. Larger, multi-center randomized controlled trials are needed to evaluate the efficacy of these therapies.

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Data availability

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Authors and Affiliations

  1. Department of Internal Medicine, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA

    Rahul Bussa, Mohammad Ahmed, Sterling Wheaten & Eric Zimmerman

  2. Division of Cardiology, Penn State Hershey Medical Center, Heart and Vascular Institute, Hershey, PA, USA

    Matthew Nudy, Mario D. Gonzalez, Gerald V. Naccarelli & Ankit Maheshwari

  3. Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, PA, USA

    Matthew Nudy

  4. Department of Biochemistry and Molecular Biology, University of Massachusetts Amherst, Amherst, MA, USA

    Jatin Bussa

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Bussa, R., Nudy, M., Ahmed, M. et al. Pulmonary vein isolation plus adjunctive therapy for the treatment of atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol 67, 523–537 (2024). https://doi.org/10.1007/s10840-023-01609-6

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