Comparative effectiveness of wide antral versus ostial pulmonary vein isolation: A systematic review and meta-analysis

Riccardo Proietti, Pasquale Santangeli, Luigi Di Biase, Jacqueline Joza, Martin Louis Bernier, Yang Wang, Antonio Sagone, Maurizio Viecca, Vidal Essebag, Andrea Natale

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background-For the past decade, electric pulmonary vein isolation (PVI) has become a procedure implemented worldwide for the treatment of atrial fibrillation. Currently, 2 main approaches are used for PVI: ostial isolation of the PVs and wide antral PVI. The aims of this systematic review are to evaluate the relative merits of each technique with a pooled comparative analysis of efficacy and complications. Methods and Results-Studies were identified by searching electronic databases for studies on ostial versus antral PVI. Information was extracted from each included trial. Odds ratio was the primary measure of treatment effect or side effects. The proportion of patients with recurrences of atrial fibrillation or other atrial tachyarrhythmias was evaluated at the end of the follow-up periods in 12 trials, including 1183 patients. The recurrence rate of total supraventricular arrhythmias was significantly lower in wide antral than in segmental PVI group (odds ratio, 0.42; 95% confidence interval, 0.32- 0.56; P<0.00001). Atrial fibrillation recurrence was significantly lower in the wide antral group (odds ratio, 0.33; 95% confidence interval, 0.24-0.46; P<0,00001). A trend toward a higher incidence of left atrial tachycardia occurrence in the wide antral circumferential ablation group was detected, which did not reach statistical significance (odds ratio, 1.53; 95% confidence interval, 0.88-2.69; P=0.13). Conclusions-Our primary finding is that PVI performed with a wide antral approach is more effective than ostial PVI in achieving freedom from total atrial tachyarrhythmia recurrence at long-term follow-up.

Original languageEnglish (US)
Pages (from-to)39-45
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume7
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Pulmonary Veins
Meta-Analysis
Odds Ratio
Tachycardia
Atrial Fibrillation
Recurrence
Confidence Intervals
Antral
Cardiac Arrhythmias
Databases
Incidence
Therapeutics

Keywords

  • Atrial fibrillation
  • Atrial fibrillation ablation
  • Pulmonary vein isolation
  • Wide antral

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Comparative effectiveness of wide antral versus ostial pulmonary vein isolation : A systematic review and meta-analysis. / Proietti, Riccardo; Santangeli, Pasquale; Di Biase, Luigi; Joza, Jacqueline; Bernier, Martin Louis; Wang, Yang; Sagone, Antonio; Viecca, Maurizio; Essebag, Vidal; Natale, Andrea.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 7, No. 1, 2014, p. 39-45.

Research output: Contribution to journalArticle

Proietti, Riccardo ; Santangeli, Pasquale ; Di Biase, Luigi ; Joza, Jacqueline ; Bernier, Martin Louis ; Wang, Yang ; Sagone, Antonio ; Viecca, Maurizio ; Essebag, Vidal ; Natale, Andrea. / Comparative effectiveness of wide antral versus ostial pulmonary vein isolation : A systematic review and meta-analysis. In: Circulation: Arrhythmia and Electrophysiology. 2014 ; Vol. 7, No. 1. pp. 39-45.
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abstract = "Background-For the past decade, electric pulmonary vein isolation (PVI) has become a procedure implemented worldwide for the treatment of atrial fibrillation. Currently, 2 main approaches are used for PVI: ostial isolation of the PVs and wide antral PVI. The aims of this systematic review are to evaluate the relative merits of each technique with a pooled comparative analysis of efficacy and complications. Methods and Results-Studies were identified by searching electronic databases for studies on ostial versus antral PVI. Information was extracted from each included trial. Odds ratio was the primary measure of treatment effect or side effects. The proportion of patients with recurrences of atrial fibrillation or other atrial tachyarrhythmias was evaluated at the end of the follow-up periods in 12 trials, including 1183 patients. The recurrence rate of total supraventricular arrhythmias was significantly lower in wide antral than in segmental PVI group (odds ratio, 0.42; 95{\%} confidence interval, 0.32- 0.56; P<0.00001). Atrial fibrillation recurrence was significantly lower in the wide antral group (odds ratio, 0.33; 95{\%} confidence interval, 0.24-0.46; P<0,00001). A trend toward a higher incidence of left atrial tachycardia occurrence in the wide antral circumferential ablation group was detected, which did not reach statistical significance (odds ratio, 1.53; 95{\%} confidence interval, 0.88-2.69; P=0.13). Conclusions-Our primary finding is that PVI performed with a wide antral approach is more effective than ostial PVI in achieving freedom from total atrial tachyarrhythmia recurrence at long-term follow-up.",
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T1 - Comparative effectiveness of wide antral versus ostial pulmonary vein isolation

T2 - A systematic review and meta-analysis

AU - Proietti, Riccardo

AU - Santangeli, Pasquale

AU - Di Biase, Luigi

AU - Joza, Jacqueline

AU - Bernier, Martin Louis

AU - Wang, Yang

AU - Sagone, Antonio

AU - Viecca, Maurizio

AU - Essebag, Vidal

AU - Natale, Andrea

PY - 2014

Y1 - 2014

N2 - Background-For the past decade, electric pulmonary vein isolation (PVI) has become a procedure implemented worldwide for the treatment of atrial fibrillation. Currently, 2 main approaches are used for PVI: ostial isolation of the PVs and wide antral PVI. The aims of this systematic review are to evaluate the relative merits of each technique with a pooled comparative analysis of efficacy and complications. Methods and Results-Studies were identified by searching electronic databases for studies on ostial versus antral PVI. Information was extracted from each included trial. Odds ratio was the primary measure of treatment effect or side effects. The proportion of patients with recurrences of atrial fibrillation or other atrial tachyarrhythmias was evaluated at the end of the follow-up periods in 12 trials, including 1183 patients. The recurrence rate of total supraventricular arrhythmias was significantly lower in wide antral than in segmental PVI group (odds ratio, 0.42; 95% confidence interval, 0.32- 0.56; P<0.00001). Atrial fibrillation recurrence was significantly lower in the wide antral group (odds ratio, 0.33; 95% confidence interval, 0.24-0.46; P<0,00001). A trend toward a higher incidence of left atrial tachycardia occurrence in the wide antral circumferential ablation group was detected, which did not reach statistical significance (odds ratio, 1.53; 95% confidence interval, 0.88-2.69; P=0.13). Conclusions-Our primary finding is that PVI performed with a wide antral approach is more effective than ostial PVI in achieving freedom from total atrial tachyarrhythmia recurrence at long-term follow-up.

AB - Background-For the past decade, electric pulmonary vein isolation (PVI) has become a procedure implemented worldwide for the treatment of atrial fibrillation. Currently, 2 main approaches are used for PVI: ostial isolation of the PVs and wide antral PVI. The aims of this systematic review are to evaluate the relative merits of each technique with a pooled comparative analysis of efficacy and complications. Methods and Results-Studies were identified by searching electronic databases for studies on ostial versus antral PVI. Information was extracted from each included trial. Odds ratio was the primary measure of treatment effect or side effects. The proportion of patients with recurrences of atrial fibrillation or other atrial tachyarrhythmias was evaluated at the end of the follow-up periods in 12 trials, including 1183 patients. The recurrence rate of total supraventricular arrhythmias was significantly lower in wide antral than in segmental PVI group (odds ratio, 0.42; 95% confidence interval, 0.32- 0.56; P<0.00001). Atrial fibrillation recurrence was significantly lower in the wide antral group (odds ratio, 0.33; 95% confidence interval, 0.24-0.46; P<0,00001). A trend toward a higher incidence of left atrial tachycardia occurrence in the wide antral circumferential ablation group was detected, which did not reach statistical significance (odds ratio, 1.53; 95% confidence interval, 0.88-2.69; P=0.13). Conclusions-Our primary finding is that PVI performed with a wide antral approach is more effective than ostial PVI in achieving freedom from total atrial tachyarrhythmia recurrence at long-term follow-up.

KW - Atrial fibrillation

KW - Atrial fibrillation ablation

KW - Pulmonary vein isolation

KW - Wide antral

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