Efficacy of adjunctive ablation of complex fractionated atrial electrograms and pulmonary vein isolation for the treatment of atrial fibrillation: a meta-analysis of randomized controlled trials

Melissa H Kong, Jonathan P Piccini, Tristram D Bahnson
Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology 2011, 13 (2): 193-204

AIMS: Although useful, percutaneous left atrial ablation for pulmonary vein isolation (PVI) does not eliminate atrial fibrillation (AF) in all patients. The ablation of complex fractionated atrial electrograms (CFAEs) has been proposed as an adjunctive strategy to improve the maintenance of sinus rhythm after PVI. Our objective was to analyse the efficacy of adjunctive CFAE ablation.

METHODS AND RESULTS: We meta-analysed six randomized controlled trials (total, n=538) using random-effects modelling to compare PVI (n=291) with PVI plus CFAE ablation (PVI+CFAE) (n=237). The primary outcome was freedom from AF or other atrial tachyarrhythmias (ATs) after a single ablation with or without antiarrhythmic drugs. Following a single ablation, PVI+CFAE improved the odds of freedom from any AF/AT compared with PVI alone (odds ratio 2.0, 95% confidence interval 1.04-3.8, P=0.04) at ≥3-month follow-up. There was moderate heterogeneity among trials (I2=63.0%). Complex fractionated atrial electrogram ablation significantly increased mean procedural (178.5±66.9 vs. 331.5±92.6 min, P<0.001), mean fluoroscopy (59.5±22.2 vs. 115.5±35.3 min, P<0.001), and mean radiofrequency (RF) energy application times (46.9±36.6 vs. 74.4±43.0 min, P<0.001).

CONCLUSIONS: Pulmonary vein isolation followed by adjunctive CFAE ablation is associated with increased freedom from AF after a single procedure. Adjunctive CFAE ablation increased procedural, fluoroscopy, and RF application times, and the risk/benefit profile of adjunctive CFAE ablation deserves further evaluation with additional studies and longer-term follow-up.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"