SynthesisJournal of cardiovascular electrophysiology2025
Fibrosis-Guided Ablation in Patients With Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials.
Synthesis in Journal of cardiovascular electrophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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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.
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.
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Who cites it
6 citing papers in PubMed.
- Strategy-Specific Effects of Low-Voltage Area-Targeted Ablation Added to Pulmonary Vein Isolation: A Meta-Analysis of Randomized Controlled Trials.Journal of arrhythmia · 2026Article
- Lifestyle modification in atrial fibrillation: Mechanisms, phenotypes and ablation outcomes.Experimental physiology · 2026Review
- Functional mapping identifies early arrhythmogenic substrate in recurrent atrial fibrillation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- Comparative cardiac electrophysiological analysis between sinus rhythm and atrial fibrillation: The correlation of left atrial low-voltage substrate of sex and rhythm.Heart rhythm O2 · 2026Article
- Discovery ofDiagnostics (Basel, Switzerland) · 2025Article
- High-density evaluation of the arrhythmogenic substrate in persistent atrial fibrillation.Heart rhythm O2 · 2025Article
Corrections and comments
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Authors and funding
14 authors.
Funding
Abstract
Ablation of fibrotic atrial regions has been suggested to improve the results of atrial fibrillation (AF) catheter ablation. We aimed to evaluate the efficacy and safety of fibrosis-guided ablation in addition to pulmonary vein isolation (PVI) among AF patients undergoing ablation through a systematic review of randomized controlled trials. The review protocol was registered on PROSPERO (CRD42024561077). Database searches were conducted on EMBASE and MEDLINE until 6th September 2024. Freedom from atrial arrhythmia (including AF and/or atrial tachycardia) and periprocedural complications were the main outcomes. Twelve trials (total of 3,066 patients) were included in the analysis. Ten studies utilized three-dimensional electroanatomic voltage mapping, and two used magnetic resonance imaging (MRI) to map atrial fibrosis. Compared to PVI, adjunctive fibrosis-guided ablation significantly improved freedom from atrial arrhythmia (risk ratio [RR] 1.13; 95% confidence interval [CI] 1.04 - 1.23; p = 0.004; I² = 35%). This benefit was seen in persistent AF (RR 1.13; 95% CI 1.01 - 1.25; p = 0.03), but not paroxysmal AF (RR 1.16; 95% CI 0.83 - 1.61; p = 0.20). Only low-voltage area ablation showed improved freedom from atrial arrhythmias (RR 1.17; 95% CI 1.06 - 1.28 vs. RR 1.03; 95% CI 0.80 - 1.32 using MRI-voltage detection). A numerically, but nonsignificant, higher rate of periprocedural complications was observed with fibrosis-guided ablation (4.4% vs. 2.8%; RR 1.44; 95% CI 0.82-2.56; p = 0.18) driven by the results of the DECAAF-II trial. Fibrosis-guided ablation, targeting low-voltage areas on electroanatomic mapping, may be an effective adjunctive target to PVI for improving AF freedom, particularly for persistent AF. However, this approach poses safety concerns.
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