PO-02-066 ABLATION STRATEGIES FOR PATIENTS WITH NON-PAROXYSMAL ATRIAL FIBRILLATION- NETWORK META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

Abstract

Pulmonary vein isolation (PVI) is the preferred ablation strategy for patients with paroxysmal atrial fibrillation (AF). However, for patients with non-paroxysmal AF (NPAF), there is no consensus on the most efficient ablation strategy (AS). We aimed to compare the efficacy and safety of different ablation strategies for patients with non-paroxysmal Atrial Fibrillation . We performed a comprehensive systematic search using four large databases to include randomized clinical trials (RCT) evaluating different AS in patients with NPAF. We excluded studies with <100 participants. We defined the efficacy endpoint as a recurrence of atrial tachyarrhythmia (AT) >30 seconds after catheter ablation during a minimum follow-up time of 6 months (or the longest reported). We estimated log risk ratios (log RRs) using random effects network meta-analysis (NMA). Surface under the cumulative ranking curve (SUCRA) was used to rank CA strategies (higher rank suggesting higher efficacy). Safety endpoint was defined as a occurence of one of the above: femoral vascular access complication, pericarditis, stroke/transitory ischemic attack/arterial embolism, pulmonary vein stenosis, cardiac tamponade/hemopericardium/effusion, atrioesophageal fistula, septicemia, internal bleeding, phrenic nerve palsy, and death. We included data from 32 eligible RCTs, with a total of 6950 participants, mean age 59.4±8.2 and 69.3% male, randomized to 15 different AS arms in our NMA (Figure 1a). PVI isolation with concomitant posterior wall isolation (PWI) was associated with reduced incidence of AT (log RR 0.67( 0.47; 0.96) compared to PVI alone. Otherwise, there was no significant difference in the rate of AT recurrence. The top 3 rankings based on SUCRA were hybrid ablation, PVI with ethanol ablation, followed by PVI with PWI. There was a low prevalence of safety outcome- 281 (4.1%), driven predominantly by access complications - 243 (86%).There were no differences in safety endpoint between compared strategies. Our analysis suggests PVI with PWI is linked to decreased AT recurrence compared to PVI. Hybrid ablation represents an attractive treatment option to study in patients with non-paroxysmal atrial fibrillation. Compared strategies were safe without apparent difference in incidency of safety endpoints.