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Clinical Outcomes After Radiofrequency Ablation of Atrial Fibrillation in South America: A Centre-Level Systematic Review and Meta-Analysis of Observational Data
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  • Carlos Boissonnet,
  • Mariano Giorgi,
  • Gastón Köhler,
  • Luciano García Roura,
  • Juan Ginestar,
  • Javier Guetta
Carlos Boissonnet
CEMIC

Corresponding Author:[email protected]

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Mariano Giorgi
CEMIC
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Gastón Köhler
Instituto Universitario CEMIC Escuela de Medicina
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Luciano García Roura
Instituto Universitario CEMIC Escuela de Medicina
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Juan Ginestar
Instituto Universitario CEMIC Escuela de Medicina
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Javier Guetta
CEMIC
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Abstract

Objectives To profile patients’ characteristics, in-hospital results and recurrence rates after radiofrequency ablation of atrial fibrillation (RAAF) in South America through a systematic review and meta-analysis of observational data. Methods We comprehensively searched for papers published in peer-reviewed medical journals and for abstracts presented in medical conferences of the region from January 1st, 2010, through June 29th, 2020. We included single-centre studies from South America with ≥10 patients receiving RAAF, excluding those reports aimed to specific populations such as permanent atrial fibrillation, patients with structural cardiopathy, or re-do procedures. Results Twenty-seven cohorts from 5 countries pooling 3909 patients were included in a random-effects meta-analysis. Pooled estimates for patients characteristics were age 57.6 years (95% CI 55.7-59.5), male gender 71.5% (95% CI 67.0%-75.6%), hypertension 54.2% (95% CI 45.4%-62.8%), paroxysmal atrial fibrillation 79.8% (95% CI 71.3%-94.5%), CHAD2 score 1.2 (95% CI 0.5-1.9). Pooled estimate rate of acute procedural success was 91.1% (95% CI 82.2-95.8%; I2 87.5%), and those of in-hospital complications were: stroke 0.6% (95% CI 0.3-1.2%; I2 0%), cardiac tamponade 2.3% (95% CI 1.4%-3.7%; I2 46.3%), hematoma 3.5% (95% CI 2.0-6.1; I2 57.0%), pseudoaneurysm 1.2% (95% CI 0.6-2.3; I2 0%), arteriovenous fistula 2.5% (95% CI 1.6-4.1; I2 0%), with no cases of oesophageal-atrial fistula nor death. Pooled estimate for arrhythmia recurrence (excluded 3-months blanking period) at 12 months was 19.9% (95% CI 17.0-23.1), at 24 months 26.9% (95% CI 21.7-32.8) and at 36 months 29.9% (95% CI 22.5-38.4). Conclusion In-hospital results of RAAF in South America were worse than published international registries, even when included populations profile was of lower risk as reflected in younger age and less prevalence of non-paroxysmal AF. Late and very late recurrence rates were appropriate. This study provides a real-life framework for the analysis of the performance of this technology in the region.