Cavotricuspid isthmus line in patients undergoing catheter ablation of atrial fibrillation with or without history of typical atrial flutter: A meta-analysis

Jorge Romero, Kavisha Patel, David Briceno, Dhanunjaya Lakkireddy, Mohamed Gabr, Juan C. Diaz, Isabella Alviz, Dalvert Polanco, Domenico G. Della Rocca, Prasant Mohanty, Sanghamitra Mohanty, Chintan Trivedi, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Pulmonary vein isolation (PVI) is the mainstay of catheter ablation (CA) for paroxysmal atrial fibrillation (AF). However, for persistent and long-standing persistent AF, there are no established strategies to improve the success rate of CA. Despite studies indicating that prophylactic cavotricuspid isthmus (CTI) ablation provides no or limited incremental benefit in patients with AF, it is still routinely performed worldwide. Objective: We sought to examine whether CTI ablation for AF is associated with improvement in recurrence of all-atrial arrhythmias, compared with PVI alone in patients with and without typical atrial flutter (AFL). Methods: A systematic review of PubMed, Cochrane, and Embase was performed for clinical studies including AF patients, reporting outcomes of CTI + PVI versus PVI alone. The primary efficacy endpoint was recurrence of all-atrial arrhythmias. Results: Five studies comprising 1400 patients undergoing CTI + PVI versus PVI alone were included; 1110 patients had AF without AFL, and 290 patients had coexistent AF and AFL. After a mean follow-up of 14.4 ± 4.8 months, CTI + PVI was not associated with improvement in recurrence of all-atrial arrhythmias when compared with PVI alone (risk ratio [RR]: 1.29; 95% confidence interval [CI]: 0.93–1.79;p =.13). In the subgroup analysis, there were no differences between both groups in patients with AF without AFL (RR: 1.55; 95% CI: 0.96–2.48; p =.07), and in patients with AF and AFL (RR: 0.91; 95% CI: 0.6–1.39; p =.68). Conclusion: In AF patients, irrespective of the presence of typical AFL, additional CTI ablation is not associated with improvement in recurrence of all-atrial arrhythmias, compared with PVI alone.

Original languageEnglish (US)
Pages (from-to)1987-1995
Number of pages9
JournalJournal of cardiovascular electrophysiology
Volume31
Issue number8
DOIs
StatePublished - Aug 1 2020
Externally publishedYes

Keywords

  • atrial fibrillation
  • atrial flutter
  • catheter ablation
  • cavotricuspid isthmus ablation
  • pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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