Evidence map›Paper›PMID 21037322›Full record

SynthesisEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2011

Efficacy of adjunctive ablation of complex fractionated atrial electrograms and pulmonary vein isolation for the treatment of atrial fibrillation: a meta-analysis of randomized controlled trials.

Melissa H Kong, Jonathan P Piccini, Tristram D Bahnson

Erratum issuedAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 23 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Pulmonary vein isolation plus adjunctive therapy for the treatment of atrial fibrillation: a systematic review and meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2024
    Pooled it
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  4. Comparative effectiveness of catheter ablation strategies for rhythm control in patients with atrial fibrillation: a meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2012
    Pooled it
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  6. Article
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  9. Electrogram morphology recurrence guided catheter ablation for repeat ablation of persistent atrial fibrillation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2024
    Article
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  11. Increased body mass index, age, and left atrial size are associated with altered intracardiac atrial electrograms in persistent atrial fibrillation patients.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2021
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors.

Melissa H KongDuke University Medical Center, Clinical Cardiac Electrophysiology Section of the Division of Cardiovascular Diseases, DUMC Box 31294, Durham, NC 27710, USA. kong0017@mc.duke.edu
Jonathan P Piccini
Tristram D Bahnson

Funding

DUKE TRAINING GRANT IN NEPHROLOGYT32DK007731 · NIDDK · DUKE UNIVERSITY · PI CROWLEY, STEVEN D · 1995 to 2021
$3.6M
NIDDK NIH HHS 5-T32-DK-007731-15
6 · The paper itself

Abstract

aimsAlthough useful, percutaneous left atrial ablation for pulmonary vein isolation (PVI) does not eliminate atrial fibrillation (AF) in all patients. The ablation of complex fractionated atrial electrograms (CFAEs) has been proposed as an adjunctive strategy to improve the maintenance of sinus rhythm after PVI. Our objective was to analyse the efficacy of adjunctive CFAE ablation. METHODS AND

resultsWe meta-analysed six randomized controlled trials (total, n=538) using random-effects modelling to compare PVI (n=291) with PVI plus CFAE ablation (PVI+CFAE) (n=237). The primary outcome was freedom from AF or other atrial tachyarrhythmias (ATs) after a single ablation with or without antiarrhythmic drugs. Following a single ablation, PVI+CFAE improved the odds of freedom from any AF/AT compared with PVI alone (odds ratio 2.0, 95% confidence interval 1.04-3.8, P=0.04) at ≥3-month follow-up. There was moderate heterogeneity among trials (I2=63.0%). Complex fractionated atrial electrogram ablation significantly increased mean procedural (178.5±66.9 vs. 331.5±92.6 min, P<0.001), mean fluoroscopy (59.5±22.2 vs. 115.5±35.3 min, P<0.001), and mean radiofrequency (RF) energy application times (46.9±36.6 vs. 74.4±43.0 min, P<0.001).

conclusionsPulmonary vein isolation followed by adjunctive CFAE ablation is associated with increased freedom from AF after a single procedure. Adjunctive CFAE ablation increased procedural, fluoroscopy, and RF application times, and the risk/benefit profile of adjunctive CFAE ablation deserves further evaluation with additional studies and longer-term follow-up.

Indexed as

Atrial FibrillationCatheter AblationElectrophysiologic Techniques, CardiacHumansPulmonary VeinsRandomized Controlled Trials as TopicTreatment Outcome

Identifiers

PMID21037322
PMCPMC3024038

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.