Song Zheng-Qi, Lu Xin-Yu, Xu Yu-Peng, Lin Hui, Chen Yi-He
The First Clinical Medical College, Wenzhou Medical University, Chashan, Wenzhou, Zhejiang, China.
Department of Respiratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Longwan, Wenzhou, Zhejiang, China.
J Cardiol. 2025 Mar;85(3):213-219. doi: 10.1016/j.jjcc.2024.09.008. Epub 2024 Sep 26.
The posterior left atrium (LAPW) is an important substrate for initiation and maintenance of atrial fibrillation (AF). While it has been proposed as a potential target for preventing recurrence of atrial tachyarrhythmias, it remains unclear whether electrical silence of LAPW offers additional benefits over pulmonary vein isolation (PVI) alone. We conducted a systematic review of PubMed, Medline, Embase, and Cochrane databases and identified 21 eligible studies, encompassing 1514 patients assigned to PVI + posterior wall isolation (PWI) group and 1629 patients assigned to PVI group. Over a median follow-up of 12 months, adjunctive PWI significantly improved the atrial tachyarrhythmia-free survival by 14 % in comparison to PVI alone [relative risk (RR): 1.14, 95 % confidence interval (CI): 1.04 to 1.25, p = 0.004]. This improvement was mainly attributed to a pronounced benefit for patients with persistent AF. In addition, patients undergoing PVI + PWI had a longer procedure time [weighted mean difference (WMD): 23.85, 95 % CI: 12.68 to 35.01, p < 0.001], ablation time (WMD: 9.27, 95 % CI: 5.19 to 13.54, p < 0.001), and a nearly negligible increase in fluoroscopic exposure (WMD: 2.69, 95 % CI: -0.23 to 5.62, p = 0.071). There was no increased risk of procedure-related complications between these approaches (RR: 1.06, 95 % CI: 0.71 to 1.57, p = 0.787). Compared with PVI alone, PWI adjunctive to PVI exhibited a higher procedure success of sinus rhythm maintenance in persistent AF during an index catheter ablation. Meanwhile, elongated procedure time and ablation time did not compromise the safety of extensive ablation strategy with additional PWI.
左房后壁（LAPW）是心房颤动（AF）起始和维持的重要基质。虽然它已被提议作为预防房性快速性心律失常复发的潜在靶点，但LAPW电沉默是否比单独的肺静脉隔离（PVI）具有额外益处仍不清楚。我们对PubMed、Medline、Embase和Cochrane数据库进行了系统综述，确定了21项符合条件的研究，包括1514例分配到PVI + 后壁隔离（PWI）组的患者和1629例分配到PVI组的患者。在中位随访12个月期间，与单独的PVI相比，辅助PWI显著提高了无房性快速性心律失常生存率14%[相对危险度（RR）：1.14，95%置信区间（CI）：1.04至1.25，p = 0.004]。这种改善主要归因于对持续性AF患者的显著益处。此外，接受PVI + PWI的患者手术时间更长[加权平均差（WMD）：23.85，95%CI：12.68至35.01，p < 0.001]，消融时间（WMD：9.27，95%CI：5.19至13.54，p < 0.001），透视暴露增加几乎可忽略不计（WMD：2.69，95%CI： - 0.23至5.62，p = 0.071）。这些方法之间手术相关并发症的风险没有增加（RR：1.06，95%CI：0.71至1.57，p = 0.787）。与单独的PVI相比，PVI辅助PWI在首次导管消融期间对持续性AF患者维持窦性心律的手术成功率更高。同时，延长的手术时间和消融时间并未损害额外PWI的广泛消融策略的安全性。
