TY - JOUR
T1 - Focal impulse and rotor modulation guided ablation versus pulmonary vein isolation for atrial fibrillation
T2 - A meta-analysis of head-to-head comparative studies
AU - Romero, Jorge
AU - Gabr, Mohamed
AU - Alviz, Isabella
AU - Briceno, David
AU - Diaz, Juan Carlos
AU - Rodriguez, Daniel
AU - Patel, Kavisha
AU - Polanco, Dalvert
AU - Trivedi, Chintan
AU - Mohanty, Sanghamitra
AU - Della Rocca, Domenico
AU - Lakkireddy, Dhanunjaya
AU - Natale, Andrea
AU - Di Biase, Luigi
N1 - Publisher Copyright:
© 2021 Wiley Periodicals LLC
PY - 2021/7
Y1 - 2021/7
N2 - Introduction: Empirical pulmonary vein isolation (PVI) remains the cornerstone for catheter ablation of atrial fibrillation (AF). Various ablation strategies and modalities are continually tested with the aim of improving ablation outcomes. Although focal impulse and rotor modulation (FIRM)-guided ablation is currently used as an adjunct to PVI, evidence supporting this strategy is conflicting. We sought to examine whether the utilization of FIRM-guided ablation with or without PVI is associated with a decrease in all-atrial arrhythmia recurrence as compared to PVI alone. Methods: A systematic review of PubMed, Cochrane, and Embase was performed for head-to-head study designs comparing outcomes of patients who underwent FIRM-guided ablation with or without PVI to those who underwent PVI alone. The primary efficacy endpoint was all-atrial arrhythmia recurrence. The secondary endpoints were complications rates and procedural characteristics. Results: Overall, six studies comprising 674 patients undergoing either FIRM-guided ablation ± PVI versus PVI were included (mean age 63.4 ± 9.2, male 74%, 9% paroxysmal AF, 91% nonparoxysmal AF). After a mean follow-up of 18.8 months, FIRM-guided ablation with or without PVI was not associated with improvement in all-atrial arrhythmia recurrence rate compared to PVI alone (43.4% vs. 45.9%, risk ratio [RR]: 1.06; 95% confidence interval [CI]: 0.77–1.47; p =.70). No statistically significant difference was noted in complication rates between the two groups (RR: 1.66; 95% CI: 0.08–34.54; p =.74). Conclusion: In this meta-analysis of head-to-head comparison studies, FIRM-guided ablation with or without PVI did not provide any benefit in improving all-atrial arrhythmia recurrence at follow-up when compared to PVI alone.
AB - Introduction: Empirical pulmonary vein isolation (PVI) remains the cornerstone for catheter ablation of atrial fibrillation (AF). Various ablation strategies and modalities are continually tested with the aim of improving ablation outcomes. Although focal impulse and rotor modulation (FIRM)-guided ablation is currently used as an adjunct to PVI, evidence supporting this strategy is conflicting. We sought to examine whether the utilization of FIRM-guided ablation with or without PVI is associated with a decrease in all-atrial arrhythmia recurrence as compared to PVI alone. Methods: A systematic review of PubMed, Cochrane, and Embase was performed for head-to-head study designs comparing outcomes of patients who underwent FIRM-guided ablation with or without PVI to those who underwent PVI alone. The primary efficacy endpoint was all-atrial arrhythmia recurrence. The secondary endpoints were complications rates and procedural characteristics. Results: Overall, six studies comprising 674 patients undergoing either FIRM-guided ablation ± PVI versus PVI were included (mean age 63.4 ± 9.2, male 74%, 9% paroxysmal AF, 91% nonparoxysmal AF). After a mean follow-up of 18.8 months, FIRM-guided ablation with or without PVI was not associated with improvement in all-atrial arrhythmia recurrence rate compared to PVI alone (43.4% vs. 45.9%, risk ratio [RR]: 1.06; 95% confidence interval [CI]: 0.77–1.47; p =.70). No statistically significant difference was noted in complication rates between the two groups (RR: 1.66; 95% CI: 0.08–34.54; p =.74). Conclusion: In this meta-analysis of head-to-head comparison studies, FIRM-guided ablation with or without PVI did not provide any benefit in improving all-atrial arrhythmia recurrence at follow-up when compared to PVI alone.
KW - atrial fibrillation
KW - catheter ablation
KW - focal impulse
KW - pulmonary vein isolation
KW - rotor mapping
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U2 - 10.1111/jce.15036
DO - 10.1111/jce.15036
M3 - Article
C2 - 33844385
AN - SCOPUS:85106737681
SN - 1045-3873
VL - 32
SP - 1822
EP - 1832
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 7
ER -