The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and meta-analysis of randomized controlled trials

Chanavuth Kanitsoraphan; Pattara Rattanawong; Chol Techorueangwiwat; Jakrin Kewcharoen; Raktham Mekritthikrai; Narut Prasitlumkum; Parthav Shah; Hicham El Masry

doi:10.1002/joa3.12698

The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and meta-analysis of randomized controlled trials

J Arrhythm. 2022 Mar 17;38(3):275-286. doi: 10.1002/joa3.12698. eCollection 2022 Jun.

Authors

Chanavuth Kanitsoraphan¹, Pattara Rattanawong², Chol Techorueangwiwat¹, Jakrin Kewcharoen³, Raktham Mekritthikrai⁴, Narut Prasitlumkum⁵, Parthav Shah¹, Hicham El Masry²

Affiliations

¹ University of Hawaii Internal Medicine Residency Program Honolulu Hawaii USA.
² Department of Cardiovascular Medicine Mayo Clinic Phoenix Arizona USA.
³ Department of Medicine, Division of Cardiology Loma Linda University Medical Center Loma Linda California USA.
⁴ Division of Cardiology Cook County Hospital Cook Illinois USA.
⁵ Department of cardiology University of California Riverside Riverside California USA.

Abstract

Background: Posterior wall isolation (PWI) is an emerging approach in atrial fibrillation (AF) ablation, yet its efficacy remains controversial. This is the first meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy of PWI in AF ablation.

Objective: To assess the efficacy of PWI in reducing atrial arrhythmia recurrence following initial AF ablation at long-term follow-ups when compared to conventional methods.

Methods: We conducted a literature search from inception through September 2021 in EMBASE and MEDLINE databases. We included RCTs that compared outcomes in PWI and conventional approaches of AF ablation. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratio (OR), and 95% confidence interval (CI).

Results: Eight RCT from 2009 to 2020, including 1024 AF patients, were included. PWI did not decrease overall atrial arrhythmias recurrence (RR 0.96, 95% CI:0.88-1.05, I ² = 31.6%, p-value 0.393). However, the pooled analysis showed a significant decrease in AF recurrence in PWI compared to controlled approaches (RR 0.88, 95% CI:0.81-0.96, I ² = 48.2%, p-value .004). In the subgroup analysis, PWI significantly decreased AF recurrence in the studies that included only persistent AF (RR = 0.89, 95% CI:0.80-0.98, I ² = 65.2%, p-value .014). PWI significantly decreased AF recurrence when compared to PVI with roof line (RR 0.84, 95% CI 0.74-0.95, I ² 0.00%, p-value .008).

Conclusion: Our study suggests that adding PWI significantly decreased AF recurrence in patients with persistent AF compared to controlled approaches. It highlights the importance of considering PWI during the initial procedure in this patient population.