Abstrait

Efficacy of ATP-guided pulmonary vein isolation for atrial fibrillation: metaanalysis of evidence from randomized and non-randomized controlled trials

Yuanzheng Ye, Xianhui Zhou, Yaodong Li, Jianghua Zhang, Yanmei Lu, Qiang Xing, Qina Zhou, Ling Zhang, Wenhui Zhang, Wenkui Lv, Xinchun Cheng, Bingxin Chen, Baopeng Tang, Yi Peng

Aims: This study aims to systematically evaluate the efficacy of ATP guided Pulmonary Vein Isolation (PVI) for the treatment of paroxysmal Atrial Fibrillation (AF) and persistent AF.

Methods: A systematic search was performed on PubMed, EMbase, the Cochrane Library and Medline for Randomized Controlled Trial (RCT) and Non-Randomized Controlled Trials (Non-RCT) of ATP guided PVI treatment efficacy in AF patients until February 2016. RevMan 5.3 was used for metaanalysis.

Results: Finally, 3 RCTs and 9 non-RCTs were included. There was no difference in postoperative freedom from AF for paroxysmal AF patients in 2 non-RCTs; and no difference in postoperative freedom from AF for paroxysmal and persistent AF patients in 4 non-RCTs. The overall meta-analysis results showed that AF recurrence rate was higher in ATP group than that in conventional PVI group (P<0.05). Two RCTs showed no difference in postoperative recovery rate of pulmonary vein conduction between the two groups. For 1 year postoperative freedom from AF, 2 RCTs showed no difference between ATP guided and conventional PVI groups. However, 1 year postoperative freedom from AF was significantly higher in ATP guided PVI group than that in conventional PVI group in 4 non-RCTs (P<0.001). The overall meta-analysis results also showed that 1 year postoperative freedom from AF was significantly higher in ATP guided PVI group than that in conventional PVI group (P<0.01).

Conclusions: ATP is safe and effective in identification of occult conduction in PVI.