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Temporal Trends and Lesion Sets for Persistent Atrial Fibrillation Ablation: A Meta-Analysis With Trial Sequential
Arunashis Sau1,2, Sharan Kapadia1, Sayed Al-Aidarous3
1National Heart and Lung Institute, Imperial College London, United Kingdom (A. Sau, S.K., J.H., M.B.S., A.A., D.B.K., N.S.P., F.S.N.).
Circulation. Arrhythmia and Electrophysiology
|August 17, 2023
Summary
Ablation for persistent atrial fibrillation (PsAF) success rates have improved, but adjunctive strategies beyond pulmonary vein isolation lack proven benefit. Trial sequential analysis emphasizes the need for robust trials before adopting new therapies.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Technology
Background:
- Persistent atrial fibrillation (PsAF) ablation has been performed for over two decades with modest success rates.
- Numerous adjunctive ablation strategies have been investigated but none have achieved standard practice.
- The evolution of PsAF ablation efficacy, particularly concerning adjunctive techniques, requires examination.
Conclusions:
- While overall PsAF ablation success and efficiency have improved, no adjunctive lesion set beyond pulmonary vein isolation has demonstrated consistent benefit.
- Trial sequential analysis is crucial for evaluating novel therapies and preventing premature adoption based on insufficient evidence.
- Adequately powered randomized controlled trials are essential to avoid erroneous conclusions regarding new ablation techniques.
