Long-Term Outcome of Pulmonary Vein Isolation With and Without Focal Impulse and Rotor Modulation Mapping

DOI Web Site 被引用文献1件
  • Sanghamitra Mohanty
    From the Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., C.T., C.G., D.G.D.R., L.D.B., A.N.); Dell Medical School, Austin, TX (S.M., A.N.); Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco (A.N.); MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.); and Division of Cardiology, Stanford University, CA (A.N.).
  • Prasant Mohanty
    From the Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., C.T., C.G., D.G.D.R., L.D.B., A.N.); Dell Medical School, Austin, TX (S.M., A.N.); Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco (A.N.); MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.); and Division of Cardiology, Stanford University, CA (A.N.).
  • Chintan Trivedi
    From the Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., C.T., C.G., D.G.D.R., L.D.B., A.N.); Dell Medical School, Austin, TX (S.M., A.N.); Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco (A.N.); MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.); and Division of Cardiology, Stanford University, CA (A.N.).
  • Carola Gianni
    From the Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., C.T., C.G., D.G.D.R., L.D.B., A.N.); Dell Medical School, Austin, TX (S.M., A.N.); Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco (A.N.); MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.); and Division of Cardiology, Stanford University, CA (A.N.).
  • Domenico G. Della Rocca
    From the Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., C.T., C.G., D.G.D.R., L.D.B., A.N.); Dell Medical School, Austin, TX (S.M., A.N.); Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco (A.N.); MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.); and Division of Cardiology, Stanford University, CA (A.N.).
  • Luigi Di Biase
    From the Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., C.T., C.G., D.G.D.R., L.D.B., A.N.); Dell Medical School, Austin, TX (S.M., A.N.); Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco (A.N.); MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.); and Division of Cardiology, Stanford University, CA (A.N.).
  • Andrea Natale
    From the Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., C.T., C.G., D.G.D.R., L.D.B., A.N.); Dell Medical School, Austin, TX (S.M., A.N.); Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco (A.N.); MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.); and Division of Cardiology, Stanford University, CA (A.N.).

書誌事項

タイトル別名
  • Insights From a Meta-Analysis

説明

<jats:sec> <jats:title>Background:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results:</jats:title> <jats:p> 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 <jats:italic>Q</jats:italic> test and <jats:italic>I</jats:italic> <jats:sup>2</jats:sup> . 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 ( <jats:italic>P</jats:italic> =0.21). No significant heterogeneity (total or within group) was observed in this meta-analysis (negative <jats:italic>I</jats:italic> <jats:sup>2</jats:sup> values considered equal to zero). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>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.</jats:p> </jats:sec>

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