title: Additional ablation of complex fractionated atrial electrograms after pulmonary vein isolation in patients with atrial fibrillation: a meta-analysis.
abstract: BACKGROUND
  The efficacy of additional complex fractionated atrial electrogram (CFAE) ablation after pulmonary vein antrum isolation (PVAI) in patients with atrial fibrillation (AF) remains controversial. This meta-analysis was performed to assess the additional efficacy of CFAEs ablation after a single procedure without antiarrhythmic drugs.
  
  
  RESULTS
  Trials were identified in MEDLINE, Cochrane Library, Embase, Google Scholar, reviews, and reference lists of relevant papers. Controlled cohort studies comparing the long-term efficacy of combined CFAEs plus PVAI ablation with PVAI alone were included. The primary end point was the maintenance of sinus rhythm without antiarrhythmic drugs. Seven controlled trials (9 comparisons) with a total of 622 participants (332 patients underwent PVAI plus CFAE ablation and 330 patients underwent PVAI alone) were included in the meta-analysis. In an overall pooled estimate, compared with PVI alone, long-term rates of sinus rhythm maintenance (relative risk, 1.17, 95% confidence interval, 1.03 to 1.33, P=0.019) were increased by additional CFAE ablation. Subgroup analysis demonstrated that additional CFAEs ablation increased rates of sinus rhythm maintenance in nonparoxysmal AF (relative risk, 1.35; 95% confidence interval, 1.04 to 1.75; P=0.022), whereas had no effect on patients with paroxysmal AF (relative risk, 1.04; 95% confidence interval, 0.92 to 1.18; P=0.528).
  
  
  CONCLUSIONS
  Adjuvant CFAE ablation in addition to standard PVAI increases the rate of long-term sinus rhythm maintenance in nonparoxysmal AF patients after a single procedure without antiarrhythmic drugs but does not provide additional benefit to sinus rhythm maintenance in paroxysmal AF patients.
authors.affiliation: Department of Cardiology, Peking University Hospital, Beijing, China.
authors.forename: Wei-ju
authors.initials: WJ
authors.lastname: Li
authors.forename: Yong-yi
authors.initials: YY
authors.lastname: Bai
authors.forename: Hong-yin
authors.initials: HY
authors.lastname: Zhang
authors.forename: Ri-bo
authors.initials: RB
authors.lastname: Tang
authors.forename: Cheng-long
authors.initials: CL
authors.lastname: Miao
authors.forename: Cai-hua
authors.initials: CH
authors.lastname: Sang
authors.forename: Xian-dong
authors.initials: XD
authors.lastname: Yin
authors.forename: Jian-zeng
authors.initials: JZ
authors.lastname: Dong
authors.forename: Chang-sheng
authors.initials: CS
authors.lastname: Ma
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome