Long-term outcome of pulmonary vein isolation with and without focal impulse and rotor modulation mapping: Insights from a meta-analysis

Sanghamitra Mohanty, Prasant Mohanty, Chintan Trivedi, Carola Gianni, Domenico G. Della Rocca, Luigi Di Biase, Andrea Natale

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

BACKGROUND: This meta-analysis systematically evaluated the outcome of pulmonary vein isolation (PVI) with and without focal impulse and rotor modulation (FIRM) ablation in patients with atrial fibrillation. METHODS AND RESULTS: Extensive literature search was performed for studies reporting outcomes of PVI alone and PVI+FIRM procedures. For PVI alone, only randomized trials conducted in the past 3 years reporting single-procedure off-antiarrhythmic drugs success rate at ≥12-month follow-up were included. In PVI+FIRM group, all published studies reporting single-procedure off-antiarrhythmic drugs success rate with at least 1-year follow-up were identified. Meta-analytic estimates were derived using DerSimonian and Laird random-effects models, and pooled estimates of success rate (95% confidence interval) were computed. Statistical heterogeneity was assessed using Cochran Q test and I2. Study quality was assessed using Newcastle–Ottawa Scale. Fifteen trials were included, 10 with PVI+FIRM (n=511, nonrandomized prospective design), and 5 with PVI-only trials (n=295, randomized trials). All patients in PVI-only trials had 100% nonparoxysmal atrial fibrillation, except 1 study, and no prior ablations. About 24% of PVI+FIRM population had paroxysmal atrial fibrillation. After 15.9±5.5 (median 12) months follow-up, the off-antiarrhythmic drugs pooled success rate was 50% in FIRM+PVI (95% confidence interval, 28%–72%) and 58% in PVI (95% confidence interval, 46%–71%). Difference in effect size between groups was not statistically significant (P=0.21). No significant heterogeneity (total or within group) was observed in this meta-analysis (negative I2 values considered equal to zero). CONCLUSIONS: The overall pooled estimate did not show any therapeutic benefit of PVI+FIRM approach over PVI alone, which suggests the need to reevaluate the clinical use of FIRM ablation in atrial fibrillation.

Original languageEnglish (US)
Article numbere005789
JournalCirculation: Arrhythmia and Electrophysiology
Volume11
Issue number3
DOIs
StatePublished - Mar 1 2018
Externally publishedYes

Fingerprint

Pulmonary Veins
Meta-Analysis
Atrial Fibrillation
Anti-Arrhythmia Agents
Confidence Intervals

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Pulmonary vein isolation
  • Rotors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Long-term outcome of pulmonary vein isolation with and without focal impulse and rotor modulation mapping : Insights from a meta-analysis. / Mohanty, Sanghamitra; Mohanty, Prasant; Trivedi, Chintan; Gianni, Carola; Della Rocca, Domenico G.; Di Biase, Luigi; Natale, Andrea.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 11, No. 3, e005789, 01.03.2018.

Research output: Contribution to journalArticle

Mohanty, Sanghamitra ; Mohanty, Prasant ; Trivedi, Chintan ; Gianni, Carola ; Della Rocca, Domenico G. ; Di Biase, Luigi ; Natale, Andrea. / Long-term outcome of pulmonary vein isolation with and without focal impulse and rotor modulation mapping : Insights from a meta-analysis. In: Circulation: Arrhythmia and Electrophysiology. 2018 ; Vol. 11, No. 3.
@article{77b4f9cf589a4e60bb2715f01df5f78d,
title = "Long-term outcome of pulmonary vein isolation with and without focal impulse and rotor modulation mapping: Insights from a meta-analysis",
abstract = "BACKGROUND: This meta-analysis systematically evaluated the outcome of pulmonary vein isolation (PVI) with and without focal impulse and rotor modulation (FIRM) ablation in patients with atrial fibrillation. METHODS AND RESULTS: Extensive literature search was performed for studies reporting outcomes of PVI alone and PVI+FIRM procedures. For PVI alone, only randomized trials conducted in the past 3 years reporting single-procedure off-antiarrhythmic drugs success rate at ≥12-month follow-up were included. In PVI+FIRM group, all published studies reporting single-procedure off-antiarrhythmic drugs success rate with at least 1-year follow-up were identified. Meta-analytic estimates were derived using DerSimonian and Laird random-effects models, and pooled estimates of success rate (95{\%} confidence interval) were computed. Statistical heterogeneity was assessed using Cochran Q test and I2. Study quality was assessed using Newcastle–Ottawa Scale. Fifteen trials were included, 10 with PVI+FIRM (n=511, nonrandomized prospective design), and 5 with PVI-only trials (n=295, randomized trials). All patients in PVI-only trials had 100{\%} nonparoxysmal atrial fibrillation, except 1 study, and no prior ablations. About 24{\%} of PVI+FIRM population had paroxysmal atrial fibrillation. After 15.9±5.5 (median 12) months follow-up, the off-antiarrhythmic drugs pooled success rate was 50{\%} in FIRM+PVI (95{\%} confidence interval, 28{\%}–72{\%}) and 58{\%} in PVI (95{\%} confidence interval, 46{\%}–71{\%}). Difference in effect size between groups was not statistically significant (P=0.21). No significant heterogeneity (total or within group) was observed in this meta-analysis (negative I2 values considered equal to zero). CONCLUSIONS: The overall pooled estimate did not show any therapeutic benefit of PVI+FIRM approach over PVI alone, which suggests the need to reevaluate the clinical use of FIRM ablation in atrial fibrillation.",
keywords = "Atrial fibrillation, Catheter ablation, Pulmonary vein isolation, Rotors",
author = "Sanghamitra Mohanty and Prasant Mohanty and Chintan Trivedi and Carola Gianni and {Della Rocca}, {Domenico G.} and {Di Biase}, Luigi and Andrea Natale",
year = "2018",
month = "3",
day = "1",
doi = "10.1161/CIRCEP.117.005789",
language = "English (US)",
volume = "11",
journal = "Circulation: Arrhythmia and Electrophysiology",
issn = "1941-3149",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Long-term outcome of pulmonary vein isolation with and without focal impulse and rotor modulation mapping

T2 - Insights from a meta-analysis

AU - Mohanty, Sanghamitra

AU - Mohanty, Prasant

AU - Trivedi, Chintan

AU - Gianni, Carola

AU - Della Rocca, Domenico G.

AU - Di Biase, Luigi

AU - Natale, Andrea

PY - 2018/3/1

Y1 - 2018/3/1

N2 - BACKGROUND: This meta-analysis systematically evaluated the outcome of pulmonary vein isolation (PVI) with and without focal impulse and rotor modulation (FIRM) ablation in patients with atrial fibrillation. METHODS AND RESULTS: Extensive literature search was performed for studies reporting outcomes of PVI alone and PVI+FIRM procedures. For PVI alone, only randomized trials conducted in the past 3 years reporting single-procedure off-antiarrhythmic drugs success rate at ≥12-month follow-up were included. In PVI+FIRM group, all published studies reporting single-procedure off-antiarrhythmic drugs success rate with at least 1-year follow-up were identified. Meta-analytic estimates were derived using DerSimonian and Laird random-effects models, and pooled estimates of success rate (95% confidence interval) were computed. Statistical heterogeneity was assessed using Cochran Q test and I2. Study quality was assessed using Newcastle–Ottawa Scale. Fifteen trials were included, 10 with PVI+FIRM (n=511, nonrandomized prospective design), and 5 with PVI-only trials (n=295, randomized trials). All patients in PVI-only trials had 100% nonparoxysmal atrial fibrillation, except 1 study, and no prior ablations. About 24% of PVI+FIRM population had paroxysmal atrial fibrillation. After 15.9±5.5 (median 12) months follow-up, the off-antiarrhythmic drugs pooled success rate was 50% in FIRM+PVI (95% confidence interval, 28%–72%) and 58% in PVI (95% confidence interval, 46%–71%). Difference in effect size between groups was not statistically significant (P=0.21). No significant heterogeneity (total or within group) was observed in this meta-analysis (negative I2 values considered equal to zero). CONCLUSIONS: The overall pooled estimate did not show any therapeutic benefit of PVI+FIRM approach over PVI alone, which suggests the need to reevaluate the clinical use of FIRM ablation in atrial fibrillation.

AB - BACKGROUND: This meta-analysis systematically evaluated the outcome of pulmonary vein isolation (PVI) with and without focal impulse and rotor modulation (FIRM) ablation in patients with atrial fibrillation. METHODS AND RESULTS: Extensive literature search was performed for studies reporting outcomes of PVI alone and PVI+FIRM procedures. For PVI alone, only randomized trials conducted in the past 3 years reporting single-procedure off-antiarrhythmic drugs success rate at ≥12-month follow-up were included. In PVI+FIRM group, all published studies reporting single-procedure off-antiarrhythmic drugs success rate with at least 1-year follow-up were identified. Meta-analytic estimates were derived using DerSimonian and Laird random-effects models, and pooled estimates of success rate (95% confidence interval) were computed. Statistical heterogeneity was assessed using Cochran Q test and I2. Study quality was assessed using Newcastle–Ottawa Scale. Fifteen trials were included, 10 with PVI+FIRM (n=511, nonrandomized prospective design), and 5 with PVI-only trials (n=295, randomized trials). All patients in PVI-only trials had 100% nonparoxysmal atrial fibrillation, except 1 study, and no prior ablations. About 24% of PVI+FIRM population had paroxysmal atrial fibrillation. After 15.9±5.5 (median 12) months follow-up, the off-antiarrhythmic drugs pooled success rate was 50% in FIRM+PVI (95% confidence interval, 28%–72%) and 58% in PVI (95% confidence interval, 46%–71%). Difference in effect size between groups was not statistically significant (P=0.21). No significant heterogeneity (total or within group) was observed in this meta-analysis (negative I2 values considered equal to zero). CONCLUSIONS: The overall pooled estimate did not show any therapeutic benefit of PVI+FIRM approach over PVI alone, which suggests the need to reevaluate the clinical use of FIRM ablation in atrial fibrillation.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Pulmonary vein isolation

KW - Rotors

UR - http://www.scopus.com/inward/record.url?scp=85052094428&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052094428&partnerID=8YFLogxK

U2 - 10.1161/CIRCEP.117.005789

DO - 10.1161/CIRCEP.117.005789

M3 - Article

C2 - 29545360

AN - SCOPUS:85052094428

VL - 11

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

SN - 1941-3149

IS - 3

M1 - e005789

ER -