Fibrosis‐Guided Ablation in Patients With Atrial Fibrillation: A Meta‐Analysis of Randomized Controlled Trials.
Ablation of fibrotic atrial regions has been suggested to improve the results of atrial fibrillation (AF) catheter ablation. We aimed to evaluate the efficacy and safety of fibrosis‐guided ablation in addition to pulmonary vein isolation (PVI) among AF patients undergoing ablation through a systemat...
| Publicado en: | Journal of Cardiovascular Electrophysiology Vol. 36; no. 8; pp. 2025 - 2041 |
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| Autores principales: | , , , , , , , , , , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Aug2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=187392135&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 187392135 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Aug2025 vid: 36 iid: 8 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 187392135 185677268 187392135 187392135 10.1111/jce.16723 187392135 ppf: 2025 ppct: 16 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Fibrosis‐Guided Ablation in Patients With Atrial Fibrillation: A Meta‐Analysis of Randomized Controlled Trials. aug: au: Salih, Ahmed Sutaria, Aman Montaser, Zeinab Magar, Tony Pun El Ashal, Gehad Zaghloul, Sheref Tom, Alen Jiji Ahmad, Mahmood Creta, Antonio Ali, Hussam Barra, Sergio Farkowski, Michal Cappato, Riccardo Providencia, Rui affil: School of Medicine, Imperial College London, London, UK sug: subj: Atrial Fibrillation Therapy Radiofrequency Ablation Catheter Ablation Pulmonary Veins Surgery Patient Safety Evaluation Treatment Outcomes Evaluation Human Systematic Review Meta Analysis Embase Medline Confidence Intervals Descriptive Statistics Body Surface Potential Mapping Methods Randomized Controlled Trials Funding Source ab: Ablation of fibrotic atrial regions has been suggested to improve the results of atrial fibrillation (AF) catheter ablation. We aimed to evaluate the efficacy and safety of fibrosis‐guided ablation in addition to pulmonary vein isolation (PVI) among AF patients undergoing ablation through a systematic review of randomized controlled trials. The review protocol was registered on PROSPERO (CRD42024561077). Database searches were conducted on EMBASE and MEDLINE until 6th September 2024. Freedom from atrial arrhythmia (including AF and/or atrial tachycardia) and periprocedural complications were the main outcomes. Twelve trials (total of 3,066 patients) were included in the analysis. Ten studies utilized three‐dimensional electroanatomic voltage mapping, and two used magnetic resonance imaging (MRI) to map atrial fibrosis. Compared to PVI, adjunctive fibrosis‐guided ablation significantly improved freedom from atrial arrhythmia (risk ratio [RR] 1.13; 95% confidence interval [CI] 1.04 − 1.23; p = 0.004; I² = 35%). This benefit was seen in persistent AF (RR 1.13; 95% CI 1.01 − 1.25; p = 0.03), but not paroxysmal AF (RR 1.16; 95% CI 0.83 − 1.61; p = 0.20). Only low‐voltage area ablation showed improved freedom from atrial arrhythmias (RR 1.17; 95% CI 1.06 − 1.28 vs. RR 1.03; 95% CI 0.80 − 1.32 using MRI‐voltage detection). A numerically, but nonsignificant, higher rate of periprocedural complications was observed with fibrosis‐guided ablation (4.4% vs. 2.8%; RR 1.44; 95% CI 0.82–2.56; p = 0.18) driven by the results of the DECAAF‐II trial. Fibrosis‐guided ablation, targeting low‐voltage areas on electroanatomic mapping, may be an effective adjunctive target to PVI for improving AF freedom, particularly for persistent AF. However, this approach poses safety concerns. pubtype: Academic Journal doctype: meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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