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Comparative Efficacy and Procedural Durability of Radiofrequency Ablation for Atrial Fibrillation: A Systematic Review and a Meta-Analysis

Authors
 Hyunsook Choi  ;  Eun-Cheol Park  ;  Sun Ha Jee  ;  Sohee Park 
Citation
 Journal of Health Technology Assessment (보건의료기술평가), Vol.3(1) : 26-34, 2015 
Journal Title
Journal of Health Technology Assessment(보건의료기술평가)
ISSN
 2288-5811 
Issue Date
2015
Keywords
Atrial fibrillation ; Catheter ablation ; Multielectrode ablation ; Conventional pulmonary vein ablation ; Radiofrequency ablation ; Meta-analysis
Abstract
Objectives: In patients with atrial fibrillation (AF), the success rate of pulmonary vein isolation procedure has improved with advances in three-dimensional mapping systems but procedure remains complex and time-consuming. AF ablation using a multielectrode catheters enabling both mapping and ablation have been developed to address the technical difficulties. Our objective was to systematically review current knowledge on the efficacy and procedural durability of AF ablation using a multielectrode catheter (MEA), compared to conventional pulmonary vein isolation (CPVI). Methods: We systematically searched PubMed, EMBASE, Cochrane, and Korean domestic databases for studies on MEA and CPVI. Results: Our meta-analysis showed that procedural time [standardized mean difference (SMD)=-1.17, 95% confidence interval (CI): -1.67, -0.67] and fluoroscopic time (SMD=-0.64, 95% CI: -1.04, -0.24) were significantly shorter in MEA. The risk of AF recurrence [relative risk (RR)=0.85, 95% CI: 0.76, 0.94] was significantly lower and repeat procedures (RR=0.73, 95% CI: 0.53, 1.00) tended to be lower in MEA without statistical significance. No significant between-treatment difference in complication rates was evident with a trend toward higher complication rate in MEA (RR=1.04, 95% CI: 0.55, 1.93). Conclusion: In patients undergoing catheter ablation to treat AF, the efficacies of MEA and CPVI were comparable in terms of acute procedural success and repeat procedures. However, MEA afforded the benefit of reduced procedure-related time, including procedural time, fluoroscopic time, and radiofrequency application time and lower AF recurrence. MEA was associated with a slightly higher risk of thromboembolism, but nonetheless afforded patient benefits, when skilled physicians carefully performed all procedures.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
Yonsei Authors
Park, So Hee(박소희) ORCID logo https://orcid.org/0000-0001-8513-5163
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
Jee, Sun Ha(지선하) ORCID logo https://orcid.org/0000-0001-9519-3068
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/140628
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