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@inproceedings{Sau:2019:10.1136/heartjnl-2019-BCS.32,
author = {Sau, A and Howard, J and Al-Aidarous, S and 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 = {10.1136/heartjnl-2019-BCS.32},
pages = {A31--A31},
publisher = {BMJ Publishing Group},
title = {Efficacy of pulmonary vein isolation in preventing atrial fibrillation: meta-analysis of randomized controlled trials with an invasive control procedure},
url = {http://dx.doi.org/10.1136/heartjnl-2019-BCS.32},
year = {2019}
}

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TY  - CPAPER
AB  - Introduction Pulmonary vein isolation (PVI) is a commonly used element in treatment of atrial fibrillation (AF) but has never been tested in an intentionally placebo (sham) controlled trial. Nevertheless there have been several randomized controlled trials (RCTs) in which both arms receive an ablation procedure but the only difference between treatment arms is inclusion or omission of PVI. As long as both doctor and patient have reason to believe that the procedures in both arms are effective, such RCTs could be an effective proxy for placebo controlled trials.Methods Medline and Cochrane databases were searched for RCTs comparing catheter ablation including PVI with left atrial ablation excluding PVI. The primary efficacy endpoint was freedom from AF/atrial tachycardia at 6 months. A random-effects meta-analysis was performed using the restricted maximum likelihood (REML) estimator.Results Overall, seven studies (909 patients) met inclusion criteria. Across the 7 trials, mean age was 57.3, 70.2% of participants were male. In four trials (352 patients) the non-PVI ablation procedure was performed in both arms, while PVI was performed in only one arm. The non-PVI ablation procedures were complex fractionated atrial electrogram ablation (2 studies), ganglionated plexi ablation (1 study) and focal impulse and rotor modulation (1 study). In these, AF recurrence was significantly lower when PVI was included (RR 0.48, 95% CI 0.26-0.90, I2 64.4%)In an analysis of all 7 studies, AF recurrence was significantly lower in ablation with an ablation strategy including PVI compared to one without PVI (Figure 1, RR 0.67, 95% CI 0.53-0.85, p = 0.001, I2 0%). Neither type of AF (persistent vs. paroxysmal, p=0.43) nor type of non-PVI ablation (p=0.35) were significant moderators of the effect size. A sensitivity analysis omitting each study in turn showed similar results to the primary analysis. In particular exclusion of the retracted OASIS trial showed results similar to the primar
AU  - Sau,A
AU  - Howard,J
AU  - Al-Aidarous,S
AU  - 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  - 10.1136/heartjnl-2019-BCS.32
EP  - 31
PB  - BMJ Publishing Group
PY  - 2019///
SN  - 1355-6037
SP  - 31
TI  - Efficacy of pulmonary vein isolation in preventing atrial fibrillation: meta-analysis of randomized controlled trials with an invasive control procedure
UR  - http://dx.doi.org/10.1136/heartjnl-2019-BCS.32
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000471903800033&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/74321
ER  -

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