Imperial College London
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ProfessorNicholasPeters

Faculty of Medicine, National Heart & Lung Institute

Professor of Cardiac Electrophysiology
 
 
 
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Contact

 

+44 (0)20 7594 1880n.peters Website

 
 
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Assistant

 

Ms Anastasija Schmidt +44 (0)20 7594 1880

 
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Location

 

NHLI officesSir Michael Uren HubWhite City Campus

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Summary

 

Publications

Citation

BibTex format

@article{Sau:2023:10.1161/CIRCEP.123.011861,
author = {Sau, A and Kapadia, S and Al-Aidarous, S and Howard, J and Sohaib, A and Sikkel, MB and Arnold, A and Waks, JW and Kramer, DB and Peters, NS and Ng, FS},
doi = {10.1161/CIRCEP.123.011861},
journal = {Circulation: Arrhythmia and Electrophysiology},
pages = {536--545},
title = {Temporal trends and lesion sets for persistent atrial fibrillation ablation: a meta-analysis with trial sequential analysis and meta-regression},
url = {http://dx.doi.org/10.1161/CIRCEP.123.011861},
volume = {16},
year = {2023}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: Ablation for persistent atrial fibrillation (PsAF) has been performed for over 20 years, although success rates have remained modest. Several adjunctive lesion sets have been studied but none have become standard of practice. We sought to describe how the efficacy of ablation for PsAF has evolved in this time period with a focus on the effect of adjunctive ablation strategies. METHODS: Databases were searched for prospective studies of PsAF ablation. We performed meta-regression and trial sequential analysis. RESULTS: A total of 99 studies (15424 patients) were included. Ablation for PsAF achieved the primary outcome (freedom of atrial fibrillation/atrial tachycardia rate at 12 months follow-up) in 48.2% (5% CI, 44.0-52.3). Meta-regression showed freedom from atrial arrhythmia at 12 months has improved over time, while procedure time and fluoroscopy time have significantly reduced. Through the use of cumulative meta-analyses and trial sequential analysis, we show that some ablation strategies may initially seem promising, but after several randomized controlled trials may be found to be ineffective. Trial sequential analysis showed that complex fractionated atrial electrogram ablation is ineffective and further study of this treatment would be futile, while posterior wall isolation currently does not have sufficient evidence for routine use in PsAF ablation. CONCLUSIONS: Overall success rates from PsAF ablation and procedure/fluoroscopy times have improved over time. However, no adjunctive lesion set, in addition to pulmonary vein isolation, has been conclusively demonstrated to be beneficial. Through the use of trial sequential analysis, we highlight the importance of adequately powered randomized controlled trials, to avoid reaching premature conclusions, before widespread adoption of novel therapies.
AU  - Sau,A
AU  - Kapadia,S
AU  - Al-Aidarous,S
AU  - Howard,J
AU  - Sohaib,A
AU  - Sikkel,MB
AU  - Arnold,A
AU  - Waks,JW
AU  - Kramer,DB
AU  - Peters,NS
AU  - Ng,FS
DO  - 10.1161/CIRCEP.123.011861
EP  - 545
PY  - 2023///
SN  - 1941-3084
SP  - 536
TI  - Temporal trends and lesion sets for persistent atrial fibrillation ablation: a meta-analysis with trial sequential analysis and meta-regression
T2  - Circulation: Arrhythmia and Electrophysiology
UR  - http://dx.doi.org/10.1161/CIRCEP.123.011861
UR  - https://www.ncbi.nlm.nih.gov/pubmed/37589197
UR  - https://www.ahajournals.org/doi/10.1161/CIRCEP.123.011861
UR  - http://hdl.handle.net/10044/1/106277
VL  - 16
ER  -
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