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AF Ablation With vs. Without Pulmonary Vein Isolation
Study Questions:
Is pulmonary vein isolation (PVI) necessary for successful atrial fibrillation (AF) ablation?
Methods:
This meta-analysis included six randomized clinical trials (RCTs) (n = 610 patients) that compared the outcome of AF ablation with and without PVI. The primary endpoint was freedom from AF and atrial tachycardia (AT) at 12 months.
Results:
Recurrent AF/AT was significantly less likely when the ablation strategy included PVI than when it did not (relative risk [RR], 0.54). In three of the RCTs, non-PVI ablation was performed in both study arms and PVI was also performed in one of the study arms. In these three studies, recurrent AF/AT was significantly less frequent when PVI was performed (RR, 0.32). The incremental value of PVI was not dependent on the type of AF or the non-PVI ablation strategy.
Conclusions:
The authors concluded that PVI is necessary to optimize the outcome of AF ablation.
Perspective:
The results of this meta-analysis confirm the findings of multiple observational cohort studies and the individual RCTs that have reported that the outcome of AF ablation is improved when PVI is part of the ablation strategy. In many patients with paroxysmal AF, PVI by itself is sufficient to prevent recurrences of AF. The results of the RCTs suggest that stand-alone PVI may be appropriate during a first ablation procedure for persistent AF. However, a large proportion of these patients will have recurrent AF, in which case additional non-PVI ablation often is needed to achieve a successful outcome.
Keywords: Ablation Techniques, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Pulmonary Veins, Secondary Prevention, Tachycardia, Tachycardia, Supraventricular, Treatment Outcome
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