Aims Catheter ablation of atrial fibrillation (AF) is now a mainstream procedure although long-term outcomes are uncertain. We aimed to perform a systematic review and meta-analysis of procedural outcomes at five-years and beyond. Methods and Results We searched PubMed and Embase and after screening, identified 73 studies (67,159 patients) reporting freedom from atrial arrhythmia, all-cause death, stroke, and major bleeding at ≥five-years after AF ablation. The pooled mean age was 59.7y, 71.5% male, 62.2% paroxysmal AF, and radiofrequency was used in 78.1% of studies. Pooled incidence of freedom from atrial arrhythmia at five-years was 50.6% (95%CI 45.5%-55.7%) after a single ablation and 69.7% (95%CI 63.8%-75.3%) after multiple procedures. The incidence was higher among patients with paroxysmal compared with non-paroxysmal AF after single (59.7% vs. 33.3%, p = 0.002) and multiple (80.8% vs. 60.6%, p<0.001) ablations but were comparable between radiofrequency and cryoablation. Pooled incidences of other outcomes were 6.0% (95%CI 3.2% - 9.7%) for death, 2.4% (95%CI 1.4% - 3.7%) for stroke, and 1.2% (95%CI 0.8% - 2.0%) for major bleeding at five-years. Beyond five-years, freedom from arrhythmia recurrence remained largely stable (52.3% and 64.7% after single and multiple procedures at 10 years), while risk of stroke and bleeding increased over time. Conclusion Nearly 70% of patients having multiple ablations remained free from atrial arrhythmia at five years, with the incidence slightly decreasing beyond this period. Risk of death, stroke, and major bleeding at five-years were low but increased over time, emphasizing the importance of long-term thromboembolism prevention and bleeding risk management.
Chest digital tomosynthesis (DT) has potential advantages compared to computed tomography (CT) such as radiation dose reduction. However, the role of DT in pulmonary nodule management remains investigative. We compared DT against CT for pulmonary nodule detection and size measurement. A clinical population comprising 54 nodules from 30 patients and a screening population comprising 42 nodules from 52 patients were included. Scans were independently read by two radiologists. Agreement in nodule measurements between readers and between modalities was assessed by Bland-Altman analysis using a 95% level of significance. The DT true positive fraction for the two readers was 0.44 and 0.39 in the clinical population, and 0.10 and 0.05 in the screening population. No significant inter-modality bias was observed between DT and CT measurements of nodule size, but the range of variation between modalities was approximately 30%. Inter-reader DT measurements also showed no significant bias, with a range of variation of approximately 15%. We conclude that DT has poor nodule detection sensitivity compared to CT. However, DT showed good measurement reproducibility and may be useful for monitoring growth of existing pulmonary nodules.
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