Xie X, Liu X, Chen B, Wang Q. Prophylactic Atrial Fibrillation Ablation in Atrial Flutter Patients without Atrial Fibrillation: A Meta-Analysis with Trial Sequential Analysis.
Med Sci Monit Basic Res 2018;
24:96-102. [PMID:
29959310 PMCID:
PMC6057264 DOI:
10.12659/msmbr.910338]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background
New-onset atrial fibrillation (AF) is common after atrial flutter (AFL) ablation, but it was unclear whether AF ablation could reduce the incidence of AF in AFL patients without AF history. The present meta-analysis was conducted to evaluate the benefit of prophylactic AF ablation in reducing the occurrence of AF in typical AFL patients.
Material/Methods
We systematically searched PubMed, EMBASE, and the Cochrane Library from inception to December 2017 for randomized controlled trials (RCTs) that assessed the efficacy of AF ablation in reducing the occurrence of AF in AFL patients without AF. Trial sequential analysis (TSA) was used to control random errors and calculate the required information size.
Results
Four trials (n=357 patients) met the inclusion criteria and were included in our meta-analysis. The incidence of AF after AFL ablation was 46.4%. We observed that prophylactic AF ablation reduced the AF incidence compared with simple AFL ablation (26.1% versus 46.4%, RR: 0.57, 95% CIs: 0.42–0.76, P=0.0002) with a prolonged procedure duration (P<0.00001) and fluoroscopy time (P=0.004). Further TSA indicated that more RCTs were needed to reach more conclusive results. There was no significant difference in clinical complications (P=0.33) between the 2 groups.
Conclusions
This meta-analysis provides evidence that prophylactic AF ablation may be more effective than simple AFL ablation in reducing AF incidence after AFL ablation. Large prospective RCTs are warranted to confirm the benefit of prophylactic AF ablation in AFL patients without AF history.
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