title: Is There Still a Role for Complex Fractionated Atrial Electrogram Ablation in Addition to Pulmonary Vein Isolation in Patients With Paroxysmal and Persistent Atrial Fibrillation? Meta-Analysis of 1415 Patients.
abstract: BACKGROUND
  Ablation of complex fractionated atrial electrograms (CFAEs) has been proposed as a strategy to improve outcomes in atrial fibrillation (AF) catheter ablation, but the use of this technique remains contentious. We aimed to assess the impact of CFAE ablation in addition to pulmonary vein isolation (PVI) in patients undergoing ablation for AF.
  
  
  RESULTS
  We performed a random effects meta-analysis of studies comparing PVI versus PVI+CFAE ablation. The outcomes of freedom from AF/atrial tachycardia after 1 or several ablation procedures and acute procedural-related complications were assessed. Studies were searched on MEDLINE, EMBASE, COCHRANE, and clinicaltrials.gov, and sensitivity analyses were performed. Thirteen studies including a total of 1415 patients were considered eligible. Additional ablation of CFAEs resulted in no improvement in mid-term procedural outcome or freedom from AF or atrial tachycardia (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.58-1.10; P=0.17). Sensitivity analysis of 398 paroxysmal AF ablation procedures showed no incremental benefit of CFAE ablation (OR, 0.80; 95% CI, 0.46-1.38; P=0.42). PVI+CFAE ablation versus PVI alone did not improve the overall rate of freedom from AF or atrial tachycardia in patients with persistent AF (OR, 1.01; 95% CI, 0.63-1.64; P=0.96) or longstanding persistent AF (OR, 0.84; 95% CI, 0.24-2.96; P=0.79). There was no increase in procedural-related adverse events (OR, 1.06; 95% CI, 0.41-2.75; P=0.91).
  
  
  CONCLUSIONS
  Despite the apparent safety of this technique, CFAE ablation did not improve freedom from AF/atrial tachycardia in patients with paroxysmal or persistent AF. The role of CFAE ablation in addition to PVI should be questioned and other alternatives assessed to improve the outcome of AF ablation.
authors.affiliation: From the Department of Electrophysiology, The Heart Hospital and Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.affiliation: From the Department of Electrophysiology, The Heart Hospital and Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
authors.forename: Pier D
authors.initials: PD
authors.lastname: Lambiase
authors.affiliation: From the Department of Electrophysiology, The Heart Hospital and Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Srinivasan
authors.affiliation: From the Department of Electrophysiology, The Heart Hospital and Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
authors.forename: Girish
authors.initials: G
authors.lastname: Ganesh Babu
authors.affiliation: From the Department of Electrophysiology, The Heart Hospital and Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Bronis
authors.affiliation: From the Department of Electrophysiology, The Heart Hospital and Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
authors.forename: Syed
authors.initials: S
authors.lastname: Ahsan
authors.affiliation: From the Department of Electrophysiology, The Heart Hospital and Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
authors.forename: Fakhar Z
authors.initials: FZ
authors.lastname: Khan
authors.affiliation: From the Department of Electrophysiology, The Heart Hospital and Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Chow
authors.affiliation: From the Department of Electrophysiology, The Heart Hospital and Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
authors.forename: Edward
authors.initials: E
authors.lastname: Rowland
authors.affiliation: From the Department of Electrophysiology, The Heart Hospital and Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Lowe
authors.affiliation: From the Department of Electrophysiology, The Heart Hospital and Institute of Cardiovascular Sciences, University College London, London, United Kingdom. oliver.segal@uclh.nhs.uk.
authors.forename: Oliver R
authors.initials: OR
authors.lastname: Segal
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; electrophysiology; pulmonary veins; tachycardia