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.

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.