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Persistent atrial fibrillation: A systematic review and meta-analysis of invasive strategies

Wouter R Berger1, Eva R Meulendijks1, Jacqueline Limpens2

  • 1Amsterdam UMC, University of Amsterdam, Department of Cardiology, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands.

International Journal of Cardiology
|December 17, 2018
PubMed

Insights

Minimally-invasive surgical ablation offers higher atrial fibrillation (AF) freedom than catheter ablation for persistent AF, despite increased procedural risks. Patient-tailored therapy is recommended for optimal outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Persistent atrial fibrillation (AF) carries higher stroke and mortality risks compared to paroxysmal AF (pAF).
  • Current ablation strategies for persistent AF show suboptimal outcomes, necessitating evaluation of optimal invasive rhythm control.
  • The established efficacy and safety of ablation techniques for persistent AF require contemporary assessment.

Purpose of the Study:

  • To systematically review the efficacy and safety of catheter and minimally-invasive surgical ablation for persistent AF.
  • To compare outcomes of different ablation modalities in patients with persistent AF.
  • To inform clinical decision-making regarding rhythm control strategies for persistent AF.

Main Methods:

  • Systematic literature search of EMBASE, MEDLINE, and CENTRAL databases up to July 2018.
  • Inclusion of all randomized trials comparing surgical and catheter ablation for persistent AF.
  • Analysis of AF freedom at ≥12 months without antiarrhythmic drug (AAD) use and assessment of procedural adverse events.

Main Results:

  • Minimally-invasive surgical ablation (6 studies, 7624 patients) demonstrated higher AF freedom (69%) compared to catheter ablation (56 studies, 51%).
  • Surgical ablation was associated with a higher incidence of severe procedural adverse events.
  • Catheter ablation involved a larger number of studies and patients compared to surgical ablation.

Conclusions:

  • Minimally-invasive surgical ablation provides superior AF freedom rates in persistent AF patients.
  • Higher procedural complication rates in surgical ablation warrant careful consideration.
  • A patient-tailored approach is crucial for selecting the optimal ablation strategy in persistent AF.
Abstract

Keywords:
Catheter ablationPersistent atrial fibrillationSurgical ablationSystematic review

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