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The safety and efficacy of left atrial BOX ablation in persistent atrial fibrillation:A meta-analysis
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  • Yin Xi,
  • Yang Li,
  • Wenyu Zhang,
  • Jie Hao
Yin Xi
The Second Hospital of Hebei Medical University
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Yang Li
The Second Hospital of Hebei Medical University
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Wenyu Zhang
The Second Hospital of Hebei Medical University
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Jie Hao
The Second Hospital of Hebei Medical University

Corresponding Author:[email protected]

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Abstract

Background:Catheter ablation is an effective method to control the rhythm of atrial fibrillation. Circumferential pulmonary vein isolation (CPVI) is the cornerstone of catheter ablation of atrial fibrillation.However, circumferential pulmonary vein isolation alone has a higher recurrence rate in the treatment of persistent atrial fibrillation.At present additional left atrial BOX ablation has been shown to reduce the recurrence rate in patients with persistent atrial fibrillation in some studies, but it remains controversial. Objective: This meta-analysis aimed to investigate the safety and efficacy of additional left atrial BOX ablation in the treatment of persistent atrial fibrillation, furthermore,to provide evidence-based medical evidence for catheter ablation in patients with persistent atrial fibrillation. Methods: We searched the CNKI, PubMed, Web of Science, and the Cochrane Library for randomised controlled trials that undergoing circumferential pulmonary vein isolation alone or get additional left atrial BOX ablation in patients with persistent atrial fibrillation. The search period was from the establishment of the database to January 2023. Baseline characteristics and clinical outcomes were extracted from the included studies. The primary endpoint was the recurrence rate of all atrial arrhythmias(AA) within one year postoperatively, and the secondary endpoint was the incidence of surgery-related adverse events. This meta-analysis was performed by R version 4.1.2 Results: Six randomized controlled trials involving 967 patients with persistent atrial fibrillation were included.468 patients who underwent circumferential pulmonary vein ablation + left atrial BOX ablation and 499 patients underwent circumferential pulmonary vein ablation alone.The meta-analysis results showed that circumferential pulmonary vein ablation + left atrial BOX ablation did not significantly reduce the recurrence rate of all atrial arrhythmias after catheter ablation in patients with persistent atrial fibrillation compared with circumferential pulmonary vein isolation alone (RR=0.86,95%CI=0.73-1.02,I 2=35%)。However, subgroup analysis showed that circumferential pulmonary vein ablation + left atrial BOX ablation significantly reduced the recurrence rate of all atrial arrhythmias (RR=0.67, 95% CI=0.49-0.92, I 2=15%). and the recurrence rate of atrial fibrillation (RR=0.53, 95% CI=0.37-0.77, I 2=0%) in patients with persistent atrial fibrillation when the left atrial diameter was ≤44mm. There was no significantly increase in the incidence of procedure-related adverse events (RR=1.04,95% CI=0.56-1.94, I 2=0%), but the ablation time (MD=19.77, 95% CI=15.84-23.70, I 2=0%) and procedure time (MD=15.64,95% CI=6.99-24.29, I 2=0%) due to additional ablation procedures were extended. Conclusion: Additional left atrial BOX ablation does not significantly reduce the recurrence rate of atrial arrhythmia after catheter ablation in patients with persistent atrial fibrillation, but it can significantly reduce the recurrence rate of atrial arrhythmia and atrial fibrillation in all small left atrial diameter, without increasing the risks associated with surgery.Additional left atrial BOX ablation is safe and effective. However, further evidence from additional multicenter RCT studies is needed. Keywords: Additional left atrial BOX ablation, Persistent atrial fibrillation, Catheter ablation, Meta-analysis