Additional complex fractionated atrial electrogram ablation does not improve the outcomes of non-paroxysmal atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials

• Main Authors: Yoga Waranugraha, Ardian Rizal, Dion Setiawan, Indra Jabbar Aziz
• Format: Article
• Language: English
• Published: Elsevier 2021-01-01
• Series: Indian Heart Journal
• Subjects: CFAE ablation; Pulmonary vein isolation; Non-paroxysmal atrial fibrillation
• Online Access: http://www.sciencedirect.com/science/article/pii/S0019483220302704

Background: Non-paroxysmal atrial fibrillation (AF) has a complex pathophysiological process. The standard catheter ablation approach is pulmonary vein isolation (PVI). The additional value of complex fractionated electrogram (CFAE) ablation is still unclear. We aimed to investigate the additional value of CFAE ablation for non-paroxysmal AF. Methods: We performed a systematic review and meta-analysis of randomized controlled studies up to May 2020. Articles comparing pulmonary vein isolation (PVI) plus CFAE ablation and PVI alone for AF were obtained from the electronic scientific databases. The pooled mean difference (MD) and pooled risk ratio (RR) were assessed. Results: A total of 8 randomized controlled trials (RCTs) including 1034 patients were involved. Following a single catheter ablation procedure, the presence of any atrial tachyarrhythmia (ATA) with or without the use of antiarrhythmic drugs (AADs) between both groups were not significantly different (RR = 1.1; 95% confidence interval [CI] = 0.97–1.24; p = 0.13). Similar results were also obtained for the presence of any ATA without the use of AADs (RR = 1.08; 95% CI = 0.96–1.22; p = 0.2). The additional CFAE ablation took longer procedure times (MD = 46.95 min; 95% CI = 38.27–55.63; p = < 0.01) and fluoroscopy times (MD = 11.69 min; 95% CI = 8.54–14.83; p = < 0.01). Conclusion: Additional CFAE ablation failed to improve the outcomes of non-paroxysmal AF patients. It also requires a longer duration of procedure times and fluoroscopy times.