Fibrosis-Guided Ablation in Patients With Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Imaging

Background:

• Atrial fibrillation (AF) ablation outcomes can be improved by targeting fibrotic atrial regions.
• Pulmonary vein isolation (PVI) is a standard treatment for AF.
• Fibrosis mapping techniques include electroanatomic voltage mapping and magnetic resonance imaging (MRI).

Purpose of the Study:

• To systematically review randomized controlled trials evaluating the efficacy and safety of fibrosis-guided ablation as an adjunct to PVI for AF.
• To assess the impact of fibrosis-guided ablation on freedom from atrial arrhythmias and periprocedural complications.

Main Methods:

• Systematic review of 12 randomized controlled trials involving 3,066 patients.
• Searches conducted on EMBASE and MEDLINE databases.
• Primary outcomes: freedom from atrial arrhythmia and periprocedural complications.

Main Results:

• Adjunctive fibrosis-guided ablation significantly improved freedom from atrial arrhythmia compared to PVI alone (RR 1.13; 95% CI 1.04–1.23).
• The benefit was significant in persistent AF but not in paroxysmal AF.
• Low-voltage area ablation showed improved outcomes, whereas MRI-voltage detection did not.
• A trend towards higher periprocedural complications was observed with fibrosis-guided ablation (4.4% vs. 2.8%).

Conclusions:

• Fibrosis-guided ablation, particularly targeting low-voltage areas via electroanatomic mapping, is an effective adjunct to PVI for improving AF freedom, especially in persistent AF.
• This approach may increase the risk of periprocedural complications, warranting careful consideration.