We demonstrated the numerical data as the mean and SD. We also identified important information about: the incidence of ATAs, AF or AFL following the catheter ablation procedure the procedural endpoints involved in procedural time, fluoroscopy time or RF application time and all-procedural complications. We also extracted data about patient baseline characteristics from each study, including: demographic (sex and age) AF (paroxysmal AF proportion, AF duration and CHA 2DS 2-VASc score) comorbidities (heart failure, hypertension, stroke, coronary artery disease and diabetes) and echocardiographic parameters (LVEF, left atrial diameter and left atrial volume index). Essential information about the following was extracted from each study: the name of the first author year of publication study design centres involved country number of patients type of arrhythmia blanking period duration follow-up period duration and arrhythmia detection methods. Two investigators conducted the data extraction process. This systematic review and meta-analysis study aimed to evaluate the advantage of prophylactic CTI ablation in AF patients without documented AFL. However, several previous studies about prophylaxis CTI ablation during PVI in AF patients demonstrated conflicting results. A prior meta-analysis of randomised controlled trials (RCTs) revealed that prophylactic PVI during CTI ablation successfully improved the 1-year ATAs-free survival rate. This approach has also been proposed as an additional ablation procedure to PVI for AF patients in improving ATAs-free survival. Substrate modification, linear ablation and stepwise catheter ablation approaches have been conducted with a view to improving clinical outcomes.Īblation of the cavotricuspid isthmus (CTI) is well known as the therapeutic strategy for typical AFL. However, the main issue is the high rate of atrial tachyarrhythmias (ATAs) following the catheter ablation procedure. In AF patients with left ventricular ejection fraction (LVEF) ≤35%, catheter ablation gives additional benefit in reducing hospitalisation due to worsening heart failure and all-cause mortality. Compared with antiarrhythmic drugs (AADs), catheter ablation significantly reduces the AF recurrence rate, provides better symptom control and improves the quality of life in AF patients. In contrast, AF induced by pacing protocol during typical AFL ablation is a strong predictor for AF.Ĭomplete PV isolation (PVI) by single-shot or point-by-point catheter ablation approach is the cornerstone of catheter ablation in AF patients. Pulmonary vein (PV) firing during AF episodes makes an essential contribution to initiating typical AFL. The presence of AFL is documented in 20.6% of AF patients. Conclusion: This study suggested that prophylactic CTI ablation was an ineffective and inefficient approach in AF without documented typical atrial flutter patients.ĪF and atrial flutter (AFL) commonly coexist, and reveal a strong clinical interrelationship. Additional prophylactic CTI ablation to pulmonary vein isolation significantly increased the radio frequency application time (standardised mean difference 0.52 95% CI p=0.03). Prophylactic CTI ablation was associated with a higher recurrent AF rate (33.8% versus 27.1% risk difference 0.07 95% CI p=0.02). The risk of atrial tachyarrhythmias following a successful catheter ablation procedure was greater in the pulmonary vein isolation + CTI ablation group than pulmonary vein isolation alone group (34.8% versus 28.2% risk difference 0.08 95% CI p=0.04). Results: A total of 1,476 patients from four studies were included. The pooled effects were presented as the risk difference and standardised mean difference for dichotomous and continuous outcomes, respectively. The overall effects estimation was conducted using random effects models. Methods: A systematic review and meta-analysis study was conducted.
The present study aimed to evaluate the role of prophylactic CTI ablation in this population. Background: The advantage of prophylactic cavotricuspid isthmus (CTI) ablation for AF patients without documented atrial flutter is still unclear.
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