title: Adjunctive ablation strategies improve the efficacy of pulmonary vein isolation in non-paroxysmal atrial fibrillation: a systematic review and meta-analysis.
abstract: BACKGROUND
  Pulmonary vein (PV) isolation (PVI) has suboptimal outcomes in patients with non-paroxysmal atrial fibrillation (AF). Adjunctive strategies employed to ablate non-PV triggers have shown favorable outcomes.
  
  
  OBJECTIVE
  To delineate the incremental benefit of adjunctive ablation in patients with non-paroxysmal AF through a meta-analysis.
  
  
  RESULTS
  Database searches through August 2016 identified five non-randomized and seven randomized controlled trials (enrolling 1694 patients). The adjunctive strategies employed for non-PV ablation included focal impulse and rotor modulation; empirical linear lines, ablation of complex fractionated atrial electrograms and ganglionated plexi. The risk ratio (RR) for AF recurrence, calculated with random effects meta-analysis showed a 36% reduction of AF recurrence at a median follow up of 12 months (RR: 0.64, 95% Confidence interval: 0.48 to 0.85; p = 0.003). The benefits persisted during longer follow up when assessed in subgroup analysis.
  
  
  CONCLUSIONS
  Addition of adjunctive ablation to PVI improves outcomes.
authors.affiliation: a Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital , The Wexner Medical Center at the Ohio State University Medical Center , Columbus , OH , USA.
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Afzal
authors.affiliation: b Division of Cardiovascular Medicine , University of Kansas Medical Center , Kansas City , KS , USA.
authors.forename: Anweshan
authors.initials: A
authors.lastname: Samanta
authors.affiliation: b Division of Cardiovascular Medicine , University of Kansas Medical Center , Kansas City , KS , USA.
authors.forename: Jawaria
authors.initials: J
authors.lastname: Chatta
authors.affiliation: b Division of Cardiovascular Medicine , University of Kansas Medical Center , Kansas City , KS , USA.
authors.forename: Brihh
authors.initials: B
authors.lastname: Ansari
authors.affiliation: b Division of Cardiovascular Medicine , University of Kansas Medical Center , Kansas City , KS , USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Atherton
authors.affiliation: b Division of Cardiovascular Medicine , University of Kansas Medical Center , Kansas City , KS , USA.
authors.forename: Syed
authors.initials: S
authors.lastname: Sabzwari
authors.affiliation: b Division of Cardiovascular Medicine , University of Kansas Medical Center , Kansas City , KS , USA.
authors.forename: Mohit
authors.initials: M
authors.lastname: Turagam
authors.affiliation: b Division of Cardiovascular Medicine , University of Kansas Medical Center , Kansas City , KS , USA.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.affiliation: a Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital , The Wexner Medical Center at the Ohio State University Medical Center , Columbus , OH , USA.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Houmsse
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D016896:Treatment Outcome
keywords: Atrial fibrillation; adjunctive ablation; meta-analysis; randomized controlled trials; recurrence