Left Atrial Posterior Wall Isolation in Addition to Pulmonary Vein Isolation Using a Pentaspline Catheter in Pulsed-field Ablation for Atrial Fibrillation: A Systematic Review and Meta-analysis

Overview

Journal Heart Rhythm O2

Date 2024 Nov 11

PMID 39524056

Authors

Raymond Pranata

William Kamarullah

Giky Karwiky

Chaerul Achmad

Mohammad Iqbal

Affiliations

Soon will be listed here.

Abstract

Background: Persistent atrial fibrillation (AF) may require extensive ablation strategies. Left atrial posterior wall isolation (LAPWI) might address potential substrates for recurrence during pulsed-field ablation (PFA).

Objective: This meta-analysis aimed to investigate the feasibility and effectiveness of LAPWI in addition to pulmonary vein isolation (PVI) using a pentaspline catheter in PFA for AF.

Methods: Comprehensive search was conducted using PubMed, SCOPUS, ScienceDirect, and EuropePMC for studies reporting LAPWI+PVI using a pentaspline catheter in PFA ablation for AF. The primary outcome was atrial tachyarrhythmia (ATa) recurrence, defined as AF/atrial flutter/atrial tachycardia after blanking period.

Results: There were 882 patients from 7 studies. The success rate of LAPWI was 100% using mean/median of 16 to 20 added PFA applications with no reported acute left atrial posterior wall reconnection and esophageal complications. In mean follow-up of 240 ± 91 days, ATa recurrence was 21% (95% CI 13%-29%; I = 84.8%) in the LAPWI+PVI group. Meta-regression analysis showed that age, left ventricular ejection fraction, and repeat procedure did not significantly influence ATa recurrence ( > .05). Each 1-mm increase in left atrial diameter, increases the chance of ATa recurrence by 6% (R = 100%, < .001, I = 0%). Meta-analysis showed no difference in terms of ATa recurrence among LAPWI+PVI patients compared with those without LAPWI (odds ratio 0.78, 95% confidence interval 0.50-1.21, = .27; I = 0%, = .86). Procedure time and fluoroscopy time did not significantly differ ( > .05).

Conclusion: LAPWI using a pentaspline catheter during PFA was feasible and did not prolong the procedure/fluoroscopy but did not reduce ATa recurrence. LAPWI may be considered during PFA, although the benefit is uncertain.

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