Low voltage area guided substrate modification in nonparoxysmal atrial fibrillation: A systematic review and meta‐analysis
Background Low voltage areas (LVAs) on left atrial (LA) bipolar voltage mapping correlate with areas of fibrosis. LVAs guided substrate modification was hypothesized to improve the success rate of atrial fibrillation (AF) ablation particularly in nonparoxysmal AF population. However, randomized cont...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2023-02, Vol.34 (2), p.455-464 |
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| creator | Moustafa, Abdelmoniem Karim, Saima Kahaly, Omar Elzanaty, Ahmed Meenakshisundaram, Chandramohan Abi‐Saleh, Bernard Eltahawy, Ehab Chacko, Paul |
| description | Background
Low voltage areas (LVAs) on left atrial (LA) bipolar voltage mapping correlate with areas of fibrosis. LVAs guided substrate modification was hypothesized to improve the success rate of atrial fibrillation (AF) ablation particularly in nonparoxysmal AF population. However, randomized controlled trials (RCTs) and observational studies yielded mixed results.
Methods
The databases of Pubmed, EMBASE and Cochrane Central databases were searched from inception to August 2022. Relevant studies comparing LVA guided substrate modification (LVA ablation) versus conventional AF ablation (non LVA ablation) in patients with nonparoxysmal AF were identified and a meta‐analysis was performed (Graphical image). The efficacy endpoints of interest were recurrence of AF and the need for repeat ablation at 1‐year. The safety endpoint of interest was adverse events for both groups. Procedure related endpoints included total procedure time and fluoroscopy time.
Results
A total of 11 studies with 1597 patients were included. A significant reduction in AF recurrence at 1‐year was observed in LVA ablation versus non LVA ablation group (risk ratio [RR] 0.63 (27% vs. 36%),95% confidence interval [CI] 0.48–0.62, p |
| doi_str_mv | 10.1111/jce.15764 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2744671818</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2774368227</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3534-78cbaa3592b7dce54a0554b2490247d438c9236390a37fd3b2f4c13369039fc3</originalsourceid><addsrcrecordid>eNp10c1u1DAQB3ALgWgpHHgBZIkLHNLaGX8k3KpV-dJKXHqPJs6k8iqJFzvpEokDj8Az8iS43cIBCV_GI_3010h_xl5KcS7zu9g5OpfaGvWInUqtRFFJYx_nv1C6gMrCCXuW0k4ICUbop-wEjNKgTH3Kvm_Dgd-GYcYb4hgJ-c3iO-p4Wto0R5yJj6HzvXc4-zBxP_EpTHuM4duaRhw4ztHn0fs2-mG4R-_4JU9rmmnMq-ORbj0dOE4dH2nGXz9-4oTDmnx6zp70OCR68TDP2PX7q-vNx2L75cOnzeW2cJDPLGzlWkTQddnazpFWKLRWbalqUSrbKahcXYKBWiDYvoO27JWTAKYWUPcOztibY-w-hq8LpbkZfXKUr50oLKkprVLGykpWmb7-h-7CEvO5d8oqMFVZ2qzeHpWLIaVIfbOPfsS4NlI0d400uZHmvpFsXz0kLu1I3V_5p4IMLo7g4Ada_5_UfN5cHSN_A7hClus</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2774368227</pqid></control><display><type>article</type><title>Low voltage area guided substrate modification in nonparoxysmal atrial fibrillation: A systematic review and meta‐analysis</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><creator>Moustafa, Abdelmoniem ; Karim, Saima ; Kahaly, Omar ; Elzanaty, Ahmed ; Meenakshisundaram, Chandramohan ; Abi‐Saleh, Bernard ; Eltahawy, Ehab ; Chacko, Paul</creator><creatorcontrib>Moustafa, Abdelmoniem ; Karim, Saima ; Kahaly, Omar ; Elzanaty, Ahmed ; Meenakshisundaram, Chandramohan ; Abi‐Saleh, Bernard ; Eltahawy, Ehab ; Chacko, Paul</creatorcontrib><description>Background
Low voltage areas (LVAs) on left atrial (LA) bipolar voltage mapping correlate with areas of fibrosis. LVAs guided substrate modification was hypothesized to improve the success rate of atrial fibrillation (AF) ablation particularly in nonparoxysmal AF population. However, randomized controlled trials (RCTs) and observational studies yielded mixed results.
Methods
The databases of Pubmed, EMBASE and Cochrane Central databases were searched from inception to August 2022. Relevant studies comparing LVA guided substrate modification (LVA ablation) versus conventional AF ablation (non LVA ablation) in patients with nonparoxysmal AF were identified and a meta‐analysis was performed (Graphical image). The efficacy endpoints of interest were recurrence of AF and the need for repeat ablation at 1‐year. The safety endpoint of interest was adverse events for both groups. Procedure related endpoints included total procedure time and fluoroscopy time.
Results
A total of 11 studies with 1597 patients were included. A significant reduction in AF recurrence at 1‐year was observed in LVA ablation versus non LVA ablation group (risk ratio [RR] 0.63 (27% vs. 36%),95% confidence interval [CI] 0.48–0.62, p < .001]. Also, redo ablation was significantly lower in LVA ablation group (RR 0.52[18% vs. 26.7%], 95% CI 0.38–0.69, p < .00133). No difference was found in the overall adverse event (RR 0.7 [4.3% vs. 5.4%], 95% CI 0.36–1.35, p = .29).
Conclusion
LVA guided substrate modification provides significant reduction in recurrence of all atrial arrhythmias at 1‐year compared with non LVA approaches in persistent and longstanding persistent AF population without increase in adverse events.
In non paroxysmal atrial fibrillation, pulmonary veins isolation and adjunctive low voltage areas (LVA) guided substrate modification are associated with significant 37% reduction in recurrence of atrial arrhythmia at 1‐ year, when compared with non LVA ablation approaches with similar safety outcome.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.15764</identifier><identifier>PMID: 36453469</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Ablation ; Adverse events ; AF ablation ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - etiology ; Atrial Fibrillation - surgery ; atrial fibrillation ablation ; Cardiac arrhythmia ; Catheter Ablation - adverse effects ; Catheter Ablation - methods ; Clinical trials ; Fibrillation ; Fibrosis ; Fluoroscopy ; Heart Atria ; Humans ; low voltage areas ; low voltage zones ; Meta-analysis ; pulmonary vein isolation ; Pulmonary Veins - surgery ; Recurrence ; substrate modification ; Time Factors ; Treatment Outcome ; Voltage</subject><ispartof>Journal of cardiovascular electrophysiology, 2023-02, Vol.34 (2), p.455-464</ispartof><rights>2022 Wiley Periodicals LLC.</rights><rights>2023 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3534-78cbaa3592b7dce54a0554b2490247d438c9236390a37fd3b2f4c13369039fc3</citedby><cites>FETCH-LOGICAL-c3534-78cbaa3592b7dce54a0554b2490247d438c9236390a37fd3b2f4c13369039fc3</cites><orcidid>0000-0001-5539-0788</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.15764$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.15764$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36453469$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moustafa, Abdelmoniem</creatorcontrib><creatorcontrib>Karim, Saima</creatorcontrib><creatorcontrib>Kahaly, Omar</creatorcontrib><creatorcontrib>Elzanaty, Ahmed</creatorcontrib><creatorcontrib>Meenakshisundaram, Chandramohan</creatorcontrib><creatorcontrib>Abi‐Saleh, Bernard</creatorcontrib><creatorcontrib>Eltahawy, Ehab</creatorcontrib><creatorcontrib>Chacko, Paul</creatorcontrib><title>Low voltage area guided substrate modification in nonparoxysmal atrial fibrillation: A systematic review and meta‐analysis</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Background
Low voltage areas (LVAs) on left atrial (LA) bipolar voltage mapping correlate with areas of fibrosis. LVAs guided substrate modification was hypothesized to improve the success rate of atrial fibrillation (AF) ablation particularly in nonparoxysmal AF population. However, randomized controlled trials (RCTs) and observational studies yielded mixed results.
Methods
The databases of Pubmed, EMBASE and Cochrane Central databases were searched from inception to August 2022. Relevant studies comparing LVA guided substrate modification (LVA ablation) versus conventional AF ablation (non LVA ablation) in patients with nonparoxysmal AF were identified and a meta‐analysis was performed (Graphical image). The efficacy endpoints of interest were recurrence of AF and the need for repeat ablation at 1‐year. The safety endpoint of interest was adverse events for both groups. Procedure related endpoints included total procedure time and fluoroscopy time.
Results
A total of 11 studies with 1597 patients were included. A significant reduction in AF recurrence at 1‐year was observed in LVA ablation versus non LVA ablation group (risk ratio [RR] 0.63 (27% vs. 36%),95% confidence interval [CI] 0.48–0.62, p < .001]. Also, redo ablation was significantly lower in LVA ablation group (RR 0.52[18% vs. 26.7%], 95% CI 0.38–0.69, p < .00133). No difference was found in the overall adverse event (RR 0.7 [4.3% vs. 5.4%], 95% CI 0.36–1.35, p = .29).
Conclusion
LVA guided substrate modification provides significant reduction in recurrence of all atrial arrhythmias at 1‐year compared with non LVA approaches in persistent and longstanding persistent AF population without increase in adverse events.
In non paroxysmal atrial fibrillation, pulmonary veins isolation and adjunctive low voltage areas (LVA) guided substrate modification are associated with significant 37% reduction in recurrence of atrial arrhythmia at 1‐ year, when compared with non LVA ablation approaches with similar safety outcome.</description><subject>Ablation</subject><subject>Adverse events</subject><subject>AF ablation</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - etiology</subject><subject>Atrial Fibrillation - surgery</subject><subject>atrial fibrillation ablation</subject><subject>Cardiac arrhythmia</subject><subject>Catheter Ablation - adverse effects</subject><subject>Catheter Ablation - methods</subject><subject>Clinical trials</subject><subject>Fibrillation</subject><subject>Fibrosis</subject><subject>Fluoroscopy</subject><subject>Heart Atria</subject><subject>Humans</subject><subject>low voltage areas</subject><subject>low voltage zones</subject><subject>Meta-analysis</subject><subject>pulmonary vein isolation</subject><subject>Pulmonary Veins - surgery</subject><subject>Recurrence</subject><subject>substrate modification</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Voltage</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10c1u1DAQB3ALgWgpHHgBZIkLHNLaGX8k3KpV-dJKXHqPJs6k8iqJFzvpEokDj8Az8iS43cIBCV_GI_3010h_xl5KcS7zu9g5OpfaGvWInUqtRFFJYx_nv1C6gMrCCXuW0k4ICUbop-wEjNKgTH3Kvm_Dgd-GYcYb4hgJ-c3iO-p4Wto0R5yJj6HzvXc4-zBxP_EpTHuM4duaRhw4ztHn0fs2-mG4R-_4JU9rmmnMq-ORbj0dOE4dH2nGXz9-4oTDmnx6zp70OCR68TDP2PX7q-vNx2L75cOnzeW2cJDPLGzlWkTQddnazpFWKLRWbalqUSrbKahcXYKBWiDYvoO27JWTAKYWUPcOztibY-w-hq8LpbkZfXKUr50oLKkprVLGykpWmb7-h-7CEvO5d8oqMFVZ2qzeHpWLIaVIfbOPfsS4NlI0d400uZHmvpFsXz0kLu1I3V_5p4IMLo7g4Ada_5_UfN5cHSN_A7hClus</recordid><startdate>202302</startdate><enddate>202302</enddate><creator>Moustafa, Abdelmoniem</creator><creator>Karim, Saima</creator><creator>Kahaly, Omar</creator><creator>Elzanaty, Ahmed</creator><creator>Meenakshisundaram, Chandramohan</creator><creator>Abi‐Saleh, Bernard</creator><creator>Eltahawy, Ehab</creator><creator>Chacko, Paul</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5539-0788</orcidid></search><sort><creationdate>202302</creationdate><title>Low voltage area guided substrate modification in nonparoxysmal atrial fibrillation: A systematic review and meta‐analysis</title><author>Moustafa, Abdelmoniem ; Karim, Saima ; Kahaly, Omar ; Elzanaty, Ahmed ; Meenakshisundaram, Chandramohan ; Abi‐Saleh, Bernard ; Eltahawy, Ehab ; Chacko, Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3534-78cbaa3592b7dce54a0554b2490247d438c9236390a37fd3b2f4c13369039fc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Ablation</topic><topic>Adverse events</topic><topic>AF ablation</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - etiology</topic><topic>Atrial Fibrillation - surgery</topic><topic>atrial fibrillation ablation</topic><topic>Cardiac arrhythmia</topic><topic>Catheter Ablation - adverse effects</topic><topic>Catheter Ablation - methods</topic><topic>Clinical trials</topic><topic>Fibrillation</topic><topic>Fibrosis</topic><topic>Fluoroscopy</topic><topic>Heart Atria</topic><topic>Humans</topic><topic>low voltage areas</topic><topic>low voltage zones</topic><topic>Meta-analysis</topic><topic>pulmonary vein isolation</topic><topic>Pulmonary Veins - surgery</topic><topic>Recurrence</topic><topic>substrate modification</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Voltage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moustafa, Abdelmoniem</creatorcontrib><creatorcontrib>Karim, Saima</creatorcontrib><creatorcontrib>Kahaly, Omar</creatorcontrib><creatorcontrib>Elzanaty, Ahmed</creatorcontrib><creatorcontrib>Meenakshisundaram, Chandramohan</creatorcontrib><creatorcontrib>Abi‐Saleh, Bernard</creatorcontrib><creatorcontrib>Eltahawy, Ehab</creatorcontrib><creatorcontrib>Chacko, Paul</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moustafa, Abdelmoniem</au><au>Karim, Saima</au><au>Kahaly, Omar</au><au>Elzanaty, Ahmed</au><au>Meenakshisundaram, Chandramohan</au><au>Abi‐Saleh, Bernard</au><au>Eltahawy, Ehab</au><au>Chacko, Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Low voltage area guided substrate modification in nonparoxysmal atrial fibrillation: A systematic review and meta‐analysis</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2023-02</date><risdate>2023</risdate><volume>34</volume><issue>2</issue><spage>455</spage><epage>464</epage><pages>455-464</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Background
Low voltage areas (LVAs) on left atrial (LA) bipolar voltage mapping correlate with areas of fibrosis. LVAs guided substrate modification was hypothesized to improve the success rate of atrial fibrillation (AF) ablation particularly in nonparoxysmal AF population. However, randomized controlled trials (RCTs) and observational studies yielded mixed results.
Methods
The databases of Pubmed, EMBASE and Cochrane Central databases were searched from inception to August 2022. Relevant studies comparing LVA guided substrate modification (LVA ablation) versus conventional AF ablation (non LVA ablation) in patients with nonparoxysmal AF were identified and a meta‐analysis was performed (Graphical image). The efficacy endpoints of interest were recurrence of AF and the need for repeat ablation at 1‐year. The safety endpoint of interest was adverse events for both groups. Procedure related endpoints included total procedure time and fluoroscopy time.
Results
A total of 11 studies with 1597 patients were included. A significant reduction in AF recurrence at 1‐year was observed in LVA ablation versus non LVA ablation group (risk ratio [RR] 0.63 (27% vs. 36%),95% confidence interval [CI] 0.48–0.62, p < .001]. Also, redo ablation was significantly lower in LVA ablation group (RR 0.52[18% vs. 26.7%], 95% CI 0.38–0.69, p < .00133). No difference was found in the overall adverse event (RR 0.7 [4.3% vs. 5.4%], 95% CI 0.36–1.35, p = .29).
Conclusion
LVA guided substrate modification provides significant reduction in recurrence of all atrial arrhythmias at 1‐year compared with non LVA approaches in persistent and longstanding persistent AF population without increase in adverse events.
In non paroxysmal atrial fibrillation, pulmonary veins isolation and adjunctive low voltage areas (LVA) guided substrate modification are associated with significant 37% reduction in recurrence of atrial arrhythmia at 1‐ year, when compared with non LVA ablation approaches with similar safety outcome.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>36453469</pmid><doi>10.1111/jce.15764</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-5539-0788</orcidid></addata></record> |
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| subjects | Ablation Adverse events AF ablation Atrial Fibrillation - diagnosis Atrial Fibrillation - etiology Atrial Fibrillation - surgery atrial fibrillation ablation Cardiac arrhythmia Catheter Ablation - adverse effects Catheter Ablation - methods Clinical trials Fibrillation Fibrosis Fluoroscopy Heart Atria Humans low voltage areas low voltage zones Meta-analysis pulmonary vein isolation Pulmonary Veins - surgery Recurrence substrate modification Time Factors Treatment Outcome Voltage |
| title | Low voltage area guided substrate modification in nonparoxysmal atrial fibrillation: A systematic review and meta‐analysis |
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