Effcacy Of Adjunctive Ablation Of Complex Fractionated Atrial Electrograms And Pulmonary Vein Isolation In Patients With Atrial Fibrillation: A Meta-analysis

Objective:To compare the clinical efficacy and safety of PVI versusPVI plus adjuvant CFAEs ablation in patients with drug resistance AF aftera single procedure through meta-analysis.Material and Method: To protocol corresponding standard (studycharacteristics，interventions，outcome indicators of measurement) of thispaper,According to these criterias, we made search strategies,the type ofliterature included randomized controlled trials(RCT) and clinicalcontrolled trials(CCT).The area of studies was not limited．A search wasconducted in PubMed，EMBASE，Cochrane Library，CBM，Elsvier，CNKI and VIP for the clinical controlled trials of PVI versus PVI plusadjuvant CFAEs ablation in patients with AF,from Juanary1，1980toAugust31，2012. The references in the included literature were alsoretrieved. and then the extracted data were analyzed by using RevMan5.1software. Results：Twelve qualified trials involving1131AF patients wereincluded. The results of meta-analysis showed that：(1) In an overall pooled estimate, compared with PVI alone, rates ofsinus rhythm maintenance (relative risk,1.17,95%confidence interval,1.04to1.32, P=0.008) were increased by additional CFAEs ablation.(2) Subgroup analysis demonstrated that additional CFAEs ablationincreased rates of sinus rhythm maintenance in paroxysmal AF (relativerisk,1.12;95%confidence interval,1.01to1.24; P=0.03).(3) Compared with PVI alone, additional CFAEs ablation increasedrates of sinus rhythm maintenance (relative risk,1.32;95%confidenceinterval,1.14to1.53; P=0.0003) in persistent AF subgroup.(4) Adjuvant complex fractionated atrial electrogram ablationsignifcantly increased mean procedural times MD=38.29，95%CI(27.27，49.31)，P＜0.0000l.(5) Adjuvant complex fractionated atrial electrogram ablationsignifcantly increased mean fuoroscopy times MD=14.81，95%CI(7.61，22.01),，P＜0.00001.(6) Adjuvant complex fractionated atrial electrogram ablationsignifcantly increased mean radiofrequency (RF) energy application timesMD=15.42，95%CI(12.56，18.28)，P＜0.00001.(7) The incidence rate of complications(3.2%vs3.4%) were not significantly different between the two groups(P=0.85).Conclusion：Pulmonary vein isolation followed by adjuvant CFAEsablation increases the rate of long-term sinus rhythm maintenance inpatients. Adjuvant CFAEs ablation increased procedural, fuoroscopy, andRF application times, and the risk/beneft profle of adjunctive CFAEsablation needs further evaluation with additional studies and longer-termfollow-up.