Safety and Effectiveness of Adjunctive Posterior Wall Isolation in Atrial Fibrillation Patients: An Updated Meta-Analysis

Abstract

As the atrial fibrillation (AF) recurrence rate remains high after pulmonary vein isolation (PVI), additional left atrial posterior wall isolation (PWI) has been studied in randomized controlled trials, however, the results are conflicting. We performed an updated meta-analysis by searching online databases for the randomized controlled trials comparing the PWI+PVI group to the PVI alone group in patients with AF. The outcomes of interest were AF recurrence, all atrial arrhythmia recurrence, and atrial flutter/atrial tachycardia (AT) recurrence. Risk ratio (RR) with a 95% confidence interval (CI) was estimated using a random effects model. A total of 1,612 patients, with 807 in the PWI+PVI group and 805 in the PVI alone group were included. The mean age was 60 (9) years, 75% were men and 71% had persistent AF. The PWI+PVI group had lower AF recurrence as compared with the PVI alone group (25% vs 32%, RR 0.73, 95% CI 0.56 to 0.96, p=0.02). There were no significant differences in all atrial arrhythmia recurrence (RR 0.90, 95% CI 0.78 to 1.04, p=0.16), atrial flutter/AT recurrence (RR 1.19, 95% CI 0.92 to 1.55, p=0.19) or adverse event rates in the 2 groups (36 vs 31; RR 1.09, 95% CI 0.67 to 1.77, p=0.73). In conclusion, adjunctive PWI in addition to PVI can be achieved with lower AF recurrence but with a nonsignificant increase in atrial flutter/AT recurrence, resulting in an overall similar rate of all atrial arrhythmia recurrence without increasing the risk of adverse events, when compared with PVI alone strategy.