Outcomes of persistent and long-standing persistent atrial fibrillation ablation: a systematic review and meta-analysis

Several techniques have been utilized for the ablation of persistent (P) and long-standing persistent (LsP) atrial fibrillation (AF); however, the best approach of substrate ablation remains poorly defined. This study aims to examine the impact of ablation approach on outcomes associated with P or L...

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Bibliographic Details
Published in:Europace (London, England) England), 2018-11, Vol.20 (FI_3), p.f366-f376
Main Authors: Clarnette, Jock A, Brooks, Anthony G, Mahajan, Rajiv, Elliott, Adrian D, Twomey, Darragh J, Pathak, Rajeev K, Kumar, Sharath, Munawar, Dian A, Young, Glenn D, Kalman, Jonathan M, Lau, Dennis H, Sanders, Prashanthan
Format: Article
Language:English
Subjects:
Aged
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - diagnosis
Atrial Fibrillation - physiopathology
Atrial Fibrillation - surgery
Catheter Ablation - adverse effects
Female
Humans
Male
Middle Aged
Progression-Free Survival
Pulmonary Veins - physiopathology
Pulmonary Veins - surgery
Recurrence
Reoperation
Risk Factors
Time Factors
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Summary:Several techniques have been utilized for the ablation of persistent (P) and long-standing persistent (LsP) atrial fibrillation (AF); however, the best approach of substrate ablation remains poorly defined. This study aims to examine the impact of ablation approach on outcomes associated with P or LsP AF ablation by conducting a meta-analysis and regression on contemporary literature. A systematic literature review was conducted up to 29 July 2015 for scientific literature reporting on outcomes associated with P or LsP AF ablation. One hundred and thirteen studies reported outcomes in a total of 18 657 patients undergoing various ablation approaches for the treatment of P-LsP AF between 2001 and 2015. The point efficacy estimate of a single-AF ablation procedure without the use of anti-arrhythmic drugs was 43% (95% CI; 39-47%). Multiple procedures and/or the use of anti-arrhythmic drugs increase success to 69% (95% CI; 66-71%). Meta-regression revealed that ablation technique (P 
ISSN:1099-5129
1532-2092
DOI:10.1093/europace/eux297