Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Quality Measures & Complications D-PO05 - Poster Session V (ID 39) Poster


Background: Pulmonary vein isolation (PVI) is the mainstay of catheter ablation (CA) for paroxysmal atrial fibrillation (AF). However, for persistent and long-standing persistent AF, there are no established strategies to improve the success rate of CA. Some studies suggest that empirical cavotricuspid isthmus (CTI) ablation may be beneficial in patients with AF for reducing recurrence of all-atrial arrhythmias, regardless of the presence of AFL.
Objective: We sought to examine whether empirical CTI ablation for AF is associated with improved outcomes, including freedom from all-atrial arrhythmias, compared to PVI alone.
Methods: A systematic review in PubMed, Cochrane, and Embase was performed for clinical studies including AF patients, in which outcomes of CTI ablation in addition to PVI was compared to PVI alone. The primary efficacy outcome was freedom from all-atrial arrhythmias.
Results: Five studies comprising 1400 patients (1110 patients without known AFL and 290 patients with coexistent AF and AFL) undergoing CTI+PVI ablation versus PVI alone were included,. After a mean follow-up of 14.4±4.8 months CTI+PVI was not associated with improved freedom from all-atrial arrhythmias when compared with PVI alone (Risk Ratio [RR]: 1.29, 95% Confidence Interval [CI]:0.93-1.79, p=0.13). In the subgroup analysis, there were no differences between the AF group (RR: 1.55, 95% CI: 0.96-2.48, p=0.07) and the AF+AFL group (RR: 0.91, 95% CI: 0.6-1.39, p=0.68).
Conclusion: In AF patients, irrespective of the presence of AFL, additional CTI ablation is not associated with improved outcomes and freedom from recurrence of all-atrial arrhythmias compared to PVI alone.