Evidence map›Paper›PMID 37773559›Full record

SynthesisJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2024

Catheter ablation using pulmonary vein isolation with versus without left atrial posterior wall isolation for persistent atrial fibrillation: an updated systematic review and meta-analysis.

Dhan Bahadur Shrestha, Bishnu Deep Pathak, Niranjan Thapa, Oshan Shrestha, Sagun Karki, Jurgen Shtembari, Nimesh K Patel, Kunal Kapoor, Gautham Kalahasty, George Bodziock and 5 more

Abstract readComparative StudyMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 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

6 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Dhan Bahadur ShresthaDepartment of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA. medhan75@gmail.com.ORCID http://orcid.org/0000-0002-8121-083X
Bishnu Deep PathakDepartment of Internal Medicine, Jibjibe Primary Health Care Center, Rasuwa, Nepal.
Niranjan ThapaDepartment of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal.
Oshan ShresthaDepartment of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal.
Sagun KarkiDepartment of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal.
Jurgen ShtembariDepartment of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA.
Nimesh K PatelDepartment of Internal Medicine, Division of Cardiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Kunal KapoorDepartment of Internal Medicine, Division of Cardiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Gautham KalahastyDepartment of Internal Medicine, Division of Electrophysiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
George BodziockDepartment of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA.
Patrick WhalenDepartment of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA.
Naga Venkata K PothineniDepartment of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, KS, USA.
Bharat NarasimhanDepartment of Cardiology, Debakey Cardiovascular Institute, Houston Methodist, Houston, TX, USA.
Jayanthi KoneruDepartment of Internal Medicine, Division of Electrophysiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Ghanshyam ShanthaDepartment of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPulmonary vein isolation (PVI) is the cornerstone of catheter ablation of atrial fibrillation (AF); however, the results are suboptimal for persistent AF. The left atrial posterior wall (LAPW) is thought to be a major additional area in initiation and perpetuation of persistent AF. Therefore, adjunctive ablation of the posterior wall may reduce AF recurrence in patients with persistent AF.

objectiveThe objective of this study was to compare outcomes of catheter ablation in patients with persistent AF using PVI alone versus a combination of PVI and LAPW isolation.

methodsLiterature search was conducted in PubMed, PubMed Central, Scopus, and Embase since inception to February 2023. Screening of studies was done via Covidence software. Risk of bias assessment was done using appropriate tools. Data extraction and a narrative synthesis were carried out accordingly.

resultsTen studies were included, of which five were randomized controlled trials. PVI with LAPW ablation group had significantly lower recurrence of overall atrial tachyarrhythmia (OR 0.47, CI 0.32-0.70) and AF (OR 0.39, CI 0.23-0.69). In sensitivity analysis, freedom from atrial arrhythmias was noted to be significantly higher in the PVI with LAPW ablation group (OR 2.22, CI 1.36-3.64). However, there was no significant difference in occurrence of atrial flutter (OR 1.36, CI 0.86-2.14) or with periprocedural adverse events (OR 1.10, CI 0.60-1.99).

conclusionLAPW ablation, in addition to PVI, significantly improves the rates of arrhythmia freedom and reduces the recurrence of overall atrial tachyarrhythmia. There was no significant difference in atrial flutter or periprocedural adverse events.

Indexed as

Atrial FibrillationCatheter AblationHeart AtriaPulmonary VeinsHumansRecurrenceAtrial fibrillationAtrial flutterFreedomPosterior wall isolationPulmonary vein isolation

Identifiers

PMID37773559

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.