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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Atrial Substrate Modification in Atrial Fibrillation: Targeting GP or CFAE? Evidence from Meta-Analysis of Clinical

Mu Qin1, Xu Liu1, Shao-Hui Wu1

  • 1Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200030, China.

Plos One
|October 21, 2016
PubMed

Insights

Adjunctive cardiac ganglionated plexi (GP) ablation with pulmonary vein isolation (PVI) improves atrial fibrillation outcomes. Complex fractionated atrial electrograms (CFAE) ablation did not show similar benefits, and was linked to more atrial tachyarrhythmia.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Interventions

Background:

  • Atrial fibrillation (AF) management often involves pulmonary vein isolation (PVI).
  • The role of adjunctive ablation techniques, such as ganglionated plexi (GP) or complex fractionated atrial electrograms (CFAE), alongside PVI remains debated.
  • Systematic analysis of clinically relevant outcomes for these adjunctive strategies is lacking.

Purpose of the Study:

  • To systematically analyze and compare the efficacy of adjunctive GP or CFAE ablation versus PVI alone for atrial fibrillation.
  • To evaluate the impact on freedom from atrial tachyarrhythmia and sinus rhythm maintenance.
  • To identify factors influencing outcomes in AF substrate modification.

Main Methods:

  • A meta-analysis of 14 randomized and non-randomized controlled trials involving 1613 patients.
  • Included studies focused on PVI alone versus PVI with adjunctive GP or CFAE ablation.
  • Outcomes analyzed included freedom from atrial tachyarrhythmia and sinus rhythm maintenance at short- and long-term follow-up.

Main Results:

  • Adjunctive GP ablation significantly increased freedom from atrial tachyarrhythmia in both short-term (OR: 1.72) and long-term (OR: 2.0) follow-up compared to PVI alone.
  • Adjunctive CFAE ablation did not significantly improve freedom from atrial tachyarrhythmia after one or repeat procedures.
  • In non-paroxysmal AF, GP ablation improved sinus rhythm maintenance (OR: 1.88), while CFAE ablation did not (OR: 1.24). CFAE ablation was associated with a higher incidence of subsequent atrial tachycardia/atrial flutter.

Conclusions:

  • Adjunctive GP ablation, when added to PVI, significantly enhances the maintenance of sinus rhythm in AF patients.
  • Adjunctive CFAE ablation does not appear to provide additional benefit over PVI alone and may be associated with a higher risk of recurrent atrial tachyarrhythmias.
  • Sample size was identified as a significant source of heterogeneity in the meta-regression analysis.

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