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Adjunct posterior wall isolation reduces the recurrence of atrial fibrillation in patients undergoing cryoballoon ablation: a systematic review and meta-analysis.
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  • Mishal Mumtaz,
  • Sidra Jabeen,
  • Ahmad Danial ,
  • Muhammad Tayyab Muzaffar Chaychi,
  • Muhammad Kashan Zaheer,
  • Aymen Mumtaz,
  • Tayebah Mumtaz,
  • Bengt Herweg
Mishal Mumtaz
Quaid-e-Azam Medical College

Corresponding Author:[email protected]

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Sidra Jabeen
Liaquat National Hospital and Medical College
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Ahmad Danial
Quaid-e-Azam Medical College
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Muhammad Tayyab Muzaffar Chaychi
Quaid-e-Azam Medical College
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Muhammad Kashan Zaheer
Liaquat National Hospital and Medical College
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Aymen Mumtaz
CMH Lahore Medical College and Institute of Dentistry
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Tayebah Mumtaz
Saint Elizabeth's Medical Center
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Bengt Herweg
University of South Florida Morsani College of Medicine
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Abstract

Background: Pulmonary vein isolation (PVI) has evolved to be an integral part of ablative therapy for atrial fibrillation (AF), however, recurrence rates of AF remain high even after complete wide area circumferential PVI. In recent years adjunct posterior wall isolation (PWI) has been performed in patients with more persistent forms of AF but the benefits remain unclear. Aim: The objective of this meta-analysis was to evaluate the efficacy of adjunct posterior wall isolation in reducing recurrence rate of AF using cryoballoon ablation (CBA). Methods: We searched PubMed, Google Scholar, Clinicaltrials.gov and Cochrane CENTRAL. We included studies comparing PVI to PVI + PWI in patients with persistent AF undergoing CBA. After data extraction and quality assessment of the studies, we assessed recurrence rates of atrial tachy-arrhythmias (AF, atrial flutter, and atrial tachycardia) as well as total ablation time and procedural adverse events. Risk ratio (RR), mean difference (MD) and 95% confidence interval (CI) were calculated using Review Manager. Results: Concomitant PWI demonstrated significant decrease in recurrence risk of AF (RR 0.48; 95% CI 0.36-0.64; p < 0.00001) as well as all atrial arrhythmias (RR 0.57; 95% CI 0.47-0.70; p < 0.0001). There was no significant difference in adverse events between both groups (RR 1.05; 95% CI 0.43-2.56; p = 0.91), whereas total ablation time was significantly increased in PVI + PWI group (MD 22.67, 95% CI, 7.61-37.73, p = 0.003). Conclusion: Adjunct PWI when compared to PVI alone decreases recurrence rates of atrial tachy-arrhythmias after CBA of persistent AF.
31 Mar 2023Submitted to Journal of Cardiovascular Electrophysiology
03 Apr 2023Review(s) Completed, Editorial Evaluation Pending
03 Apr 2023Submission Checks Completed
03 Apr 2023Assigned to Editor
10 Apr 2023Reviewer(s) Assigned
03 May 2023Editorial Decision: Revise Minor
03 Jul 20231st Revision Received
04 Jul 2023Submission Checks Completed
04 Jul 2023Assigned to Editor
04 Jul 2023Review(s) Completed, Editorial Evaluation Pending
04 Jul 2023Reviewer(s) Assigned
23 Jul 2023Editorial Decision: Accept