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Pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation: a meta-analysis of randomized, controlled trials.

Publication ,  Journal Article
Piccini, JP; Lopes, RD; Kong, MH; Hasselblad, V; Jackson, K; Al-Khatib, SM
Published in: Circ Arrhythm Electrophysiol
December 2009

BACKGROUND: Catheter ablation is an established yet evolving nonpharmacologic intervention for the maintenance of sinus rhythm in patients with atrial fibrillation (AF). The efficacy and safety of pulmonary vein isolation (PVI) compared with medical therapy remain in question. METHODS AND RESULTS: We conducted a meta-analysis of all randomized, controlled trials comparing PVI and medical therapy for the maintenance of sinus rhythm. The primary end point in this analysis was freedom from recurrent AF at 12 months. The relative efficacy of PVI was estimated using random-effects modeling according to intention to treat. We identified 6 trials that randomized a total of 693 patients with AF to PVI or control. PVI was associated with markedly increased odds of freedom from AF at 12 months of follow-up (n=266/344 [77%] versus n=102/346 [29%]; odds ratio, 9.74; 95% CI, 3.98 to 23.87). When we excluded the trial that only enrolled patients with persistent AF (Q-statistic, 2.485; P=0.647 after exclusion), PVI was associated with even greater odds of AF-free survival (15.78; 95% CI, 10.07 to 24.73). PVI was associated with a decreased hospitalization for cardiovascular causes (14 versus 93 per 100 person-years; rate ratio, 0.15; 95% CI, 0.10 to 0.23). Among those randomly assigned to PVI, 17% required a repeat PVI ablation before 12 months. The rate of major complications was 2.6% (n=9/344) in the catheter ablation group. CONCLUSIONS: Compared with a nonablation treatment strategy, PVI results in dramatically increased freedom from AF at 1 year. Although the procedure can be associated with major complications, the risk of these complications is comparable to other interventional procedures.

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Published In

Circ Arrhythm Electrophysiol

DOI

EISSN

1941-3084

Publication Date

December 2009

Volume

2

Issue

6

Start / End Page

626 / 633

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Secondary Prevention
  • Risk Assessment
  • Randomized Controlled Trials as Topic
  • Pulmonary Veins
  • Patient Selection
  • Middle Aged
  • Male
  • Humans
 

Citation

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ICMJE
MLA
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Piccini, J. P., Lopes, R. D., Kong, M. H., Hasselblad, V., Jackson, K., & Al-Khatib, S. M. (2009). Pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation: a meta-analysis of randomized, controlled trials. Circ Arrhythm Electrophysiol, 2(6), 626–633. https://doi.org/10.1161/CIRCEP.109.856633
Piccini, Jonathan P., Renato D. Lopes, Melissa H. Kong, Vic Hasselblad, Kevin Jackson, and Sana M. Al-Khatib. “Pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation: a meta-analysis of randomized, controlled trials.Circ Arrhythm Electrophysiol 2, no. 6 (December 2009): 626–33. https://doi.org/10.1161/CIRCEP.109.856633.
Piccini JP, Lopes RD, Kong MH, Hasselblad V, Jackson K, Al-Khatib SM. Pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation: a meta-analysis of randomized, controlled trials. Circ Arrhythm Electrophysiol. 2009 Dec;2(6):626–33.
Piccini, Jonathan P., et al. “Pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation: a meta-analysis of randomized, controlled trials.Circ Arrhythm Electrophysiol, vol. 2, no. 6, Dec. 2009, pp. 626–33. Pubmed, doi:10.1161/CIRCEP.109.856633.
Piccini JP, Lopes RD, Kong MH, Hasselblad V, Jackson K, Al-Khatib SM. Pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation: a meta-analysis of randomized, controlled trials. Circ Arrhythm Electrophysiol. 2009 Dec;2(6):626–633.

Published In

Circ Arrhythm Electrophysiol

DOI

EISSN

1941-3084

Publication Date

December 2009

Volume

2

Issue

6

Start / End Page

626 / 633

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Secondary Prevention
  • Risk Assessment
  • Randomized Controlled Trials as Topic
  • Pulmonary Veins
  • Patient Selection
  • Middle Aged
  • Male
  • Humans