Introduction: Atrial arrhythmias (AA), including atrial fibrillation (AF), have been reported in patients after undergoing a cavotricuspid isthmus ablation (CTI) for atrial flutter (AFL). Various studies have examined the effect of performing a pulmonary vein isolation (PVI) at the time of CTI has on recurrent AA.
Methods: We searched PubMed and Google Scholar for randomized control trials comparing the incidence of AA after CVI alone versus CVI plus (+) PVI until May 2017. Studies were included if patients were assigned to CTI or to CTI + PVI. The clinical outcomes included recurrent AA, procedure time, fluoroscopy time, and complication rate.
Results: Four randomized control trials were included in the meta-analysis. A total of 550 patients were randomized in the studies (n=336 CTI, n=214 CTI + PVI) with no difference in baseline characteristics. One study included patients with paroxysmal AF. Follow-up ranged from 12-24 months. Freedom from AA at 1 year was significantly higher in the CTI + PVI group versus CTI alone (HR 0.17 [0.09, 0.33], p< 0.00001), with an 83% RR reduction. (Fig. 1) Procedure and fluoroscopy time (reported in 3 studies) were significantly higher in the CTI + PVI group [(MD 112.79, 95% CI [65.05, 160.53], p< 0.00001) and (MD 24.48, 95%CI [7.60, 41.35], p=0.004), minutes, respectively]. Six pericardial effusions were reported in the CTI + PVI group, all managed conservatively.(Fig 2) No major complications requiring intervention were reported in either group.
Conclusions: Our meta-analysis shows addition of PVI during CTI ablation significantly reduces AA at 1 year without increasing risk of complications.