Imperial College London


Faculty of MedicineNational Heart & Lung Institute

Professor of Cardiology



+44 (0)20 7594 3381d.francis Website




Miss Juliet Holmes +44 (0)20 7594 5735




Block B Hammersmith HospitalHammersmith Campus






BibTex format

author = {Sau, A and Howard, J and Al-Aidarous, S and Ferreira-Martins, J and Al-Khayatt, B and Lim, PB and Kanagaratnam, P and Whinnett, Z and Peters, N and Sikkel, M and Francis, D and Sohaib, SMA},
doi = {10.1016/j.jacep.2019.05.012},
journal = {JACC: Clinical Electrophysiology},
pages = {968--976},
title = {Meta-analysis of randomized controlled trials of atrial fibrillation ablation with pulmonary vein isolation versus without},
url = {},
volume = {5},
year = {2019}

RIS format (EndNote, RefMan)

AB - ObjectivesThis meta-analysis examined the ability of pulmonary vein isolation (PVI) to prevent atrial fibrillation in randomized controlled trials (RCTs) in which the patients not receiving PVI nevertheless underwent a procedure.BackgroundPVI is a commonly used procedure for the treatment of atrial fibrillation (AF), and its efficacy has usually been judged against therapy with anti-arrhythmic drugs in open-label trials. There have been several RCTs of AF ablation in which both arms received an ablation, but the difference between the treatment arms was inclusion or omission of PVI. These trials of an ablation strategy with PVI versus an ablation strategy without PVI may provide a more rigorous method for evaluating the efficacy of PVI.MethodsMedline and Cochrane databases were searched for RCTs comparing ablation including PVI with ablation excluding PVI. The primary efficacy endpoint was freedom from atrial fibrillation (AF) and atrial tachycardia at 12 months. A random-effects meta-analysis was performed using the restricted maximum likelihood estimator.ResultsOverall, 6 studies (610 patients) met inclusion criteria. AF recurrence was significantly lower with an ablation including PVI than an ablation without PVI (RR: 0.54; 95% confidence interval [CI]: 0.33 to 0.89; p 1⁄4 0.0147; I2 1⁄4 79.7%). Neither the type of AF (p 1⁄4 0.48) nor the type of non-PVI ablation (p 1⁄4 0.21) was a significant moderator of the effect size. In 3 trials the non-PVI ablation procedure was performed in both arms, whereas PVI was performed in only 1 arm. In these studies, AF recurrence was significantly lower when PVI was included (RR: 0.32; 95% CI: 0.14 to 0.73; p 1⁄4 0.007, I2 78%ConclusionIn RCTs where both arms received an ablation, and therefore an expectation amongst patients and doctors of benefit, being randomized to PVI had a striking effect, reducing AF recurrence by a half.
AU - Sau,A
AU - Howard,J
AU - Al-Aidarous,S
AU - Ferreira-Martins,J
AU - Al-Khayatt,B
AU - Lim,PB
AU - Kanagaratnam,P
AU - Whinnett,Z
AU - Peters,N
AU - Sikkel,M
AU - Francis,D
AU - Sohaib,SMA
DO - 10.1016/j.jacep.2019.05.012
EP - 976
PY - 2019///
SN - 2405-5018
SP - 968
TI - Meta-analysis of randomized controlled trials of atrial fibrillation ablation with pulmonary vein isolation versus without
T2 - JACC: Clinical Electrophysiology
UR -
UR -
VL - 5
ER -