Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?: a meta-analysis
Introduction
Transcatheter atrial fibrillation (AF) ablation (TCAFA) is usually undertaken in patients with symptomatic episodes of AF resistant to at least one anti-arrhythmic drug. Multiple single center randomized studies and multicenter prospective registries comparing anti-arrhythmic drug therapy with TCAFA have shown significantly higher rates of patients in sinus rhythm after an invasive strategy at one year of follow up [1], [2], [3], [4], [5], [6].
Many observational studies have reported predictors identified by multivariate analyses including the time spent in persistent AF, structural heart disease, left ventricular impairment, and, perhaps most consistently, the left atrial diameter [7]; in the case in which they were confirmed in larger datasets these clinical features could be very useful for cardiologists and general clinicians both for a correct selection of patients deferred to an invasive strategy and to accurately manage the following procedure. However, to the best of our knowledge, no meta-analyses have been performed to appraise the results of real life observational studies of AF ablation, and their complication rates and the most powerful predictors of recurrence.
Section snippets
Methods
The present research was elaborated according to current guidelines, including the recent Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) amendment to the Quality of Reporting of Meta-analyses (QUOROM) statement, and recommendations from the Cochrane Collaboration and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) [8], [9], [10], [11].
Results
From the 3475 citations first screened, 27 complete reports were evaluated for inclusion in the present research and finally 19 studies were included in the review [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33] (Fig. 1). One study was excluded because it included patients with hypertrophic cardiomyopathy [35], one because it appraised robotic navigation [34], 4 for duplicate reporting [36], [37], [38], [39], and one because
Discussion
The main results of the present work were: a) AF ablation procedures remain burdened with in-hospital complications, although infrequent in experienced centers, b) TCAFA ablation obtains satisfactory midterm success rates, c) the success following redo procedures did not differ between paroxysmal and persistent AF, and d) valvular AF, a left atrium diameter of more than 50 mm and recurrence within 30 days, could help to better tailor the clinical and interventional strategies.
The overall
Acknowledgment
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.
Dr. D'Ascenzo conceived the project, and performed the literature search with Dr. Corleto and the analysis with Dr. Biondi-Zoccai. Prof. Gaita, Dr. Anselmino, Dr. Ferraris, Dr. di Biase, Dr. A. Natale, Dr. Hunter, Dr. Schilling, Dr. Miyazaki, Dr. Tada, Dr. Aonuma, Dr. Yenn-Jiang, Dr. Tao, Dr. Ma, Dr. Packer and Dr. Hammill participated in
References (47)
- et al.
Early complications of pulmonary vein catheter ablation for atrial fibrillation: a multicenter prospective registry on procedural safety
Heart Rhythm
(2007) - et al.
Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation: an independent predictor of procedural failure
J Am Coll Cardiol
(Jan 18 2005) - et al.
Prognostic implications of the high-sensitive C-reactive protein in the catheter ablation of atrial fibrillation
Am J Cardiol
(Feb 15 2010) - et al.
Long-term single- and multiple-procedure outcome and predictors of success after catheter ablation for persistent atrial fibrillation
Heart Rhythm
(Sep 2011) - et al.
Dual balloon size strategy for cryoisolation of the pulmonary veins in patients with atrial fibrillation: comparison of 23 and 28 mm diameter
Arch Cardiovasc Dis
(Feb 2011) - et al.
Concomitant chronic kidney disease increases the recurrence of atrial fibrillation after catheter ablation of atrial fibrillation: a mid-term follow-up
Heart Rhythm
(Mar 2011) - et al.
Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up?
J Am Coll Cardiol
(Jan 11 2011) - et al.
Impact of type of atrial fibrillation and repeat catheter ablation on long-term freedom from atrial fibrillation: results from a multicenter study
Heart Rhythm
(Oct 2009) - et al.
Catheter-induced linear lesions in the left atrium in patients with atrial fibrillation: an electroanatomic study
J Am Coll Cardiol
(Oct 1 2003) - et al.
Guidelines for the management of atrial fibrillation. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology
Europace
(2010)
Long-term outcome of right and left atrial radiofrequency ablation of persistent atrial fibrillation
Pacing Clin Electrophysiol
Significance of late recurrence of atrial fibrillation during long-term follow-up after pulmonary vein isolation
Pacing Clin Electrophysiol
Long-term outcome following successful pulmonary vein isolation: pattern and prediction of very late recurrence
J Cardiovasc Electrophysiol
Ablation of atrial fibrillation: does the addition of three-dimensional magnetic resonance imaging of the left atrium to electroanatomic mapping improve the clinical outcome? A randomized comparison of Carto-Merge vs. Carto-XP three-dimensional mapping ablation in patients with paroxysmal and persistent atrial fibrillation
Europace
Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint
Eur Heart J
Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation
Circ Arrhythm Electrophysiol
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
BMJ
Meta-analysis of observational studies in epidemiology: proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group
JAMA
Developing optimal search strategies for detecting clinically sound prognostic studies in MEDLINE: an analytic survey
BMC Med
Review of the usefulness of contacting other experts when conducting a literature search for systematic reviews
BMJ
Long-term clinical results of 2 different ablation strategies in patients with paroxysmal and persistent atrial fibrillation
Circ Arrhythm Electrophysiol
Long-term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients
Europace
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2022, Indian Heart JournalCitation Excerpt :Overall however, only a minority of paroxysmal atrial fibrillation (PAF) ablation patients underwent extra-PV ablation and only to a limited extent, thus confirming the primary role of stable pulmonary vein isolation (PVI) in PAF patients at least. Clinical and echocardiographic parameters such as hypertension, left atrial (LA) diameter and valvular AF have been identified that predict recurrence within 30 days after ablation.10 Scores combining several clinical parameters have also been developed to predict recurrence after catheter ablation.11