Biatrial versus Isolated Left Atrial Ablation in Atrial Fibrillation: A Systematic Review and Meta-Analysis

Abstract

Objective The outcomes of biatrial ablation (BA) and isolated left atrial ablation (LA) in atrial fibrillation remain inconclusive. In this meta-analysis, we assess the currently available evidence to compare outcomes between BA and LA. Methods Electronic searches were performed from database inception to December 2016, and relevant studies were accessed. Odds ratios and weight mean differences with 95% confidence intervals are reported. Twenty-one studies comprising 3609 patients were included in the present meta-analysis. Results The prevalence of sinus rhythm in the BA cohort was similar to that in the LA cohort at discharge, at 12 months, and after more than 1 year of follow-up. However, at 6 months, the prevalence of sinus rhythm was higher in the BA cohort than in the LA cohort. The rate of permanent pacemaker implantation was higher in the BA cohort than in the LA cohort. However, 30-day and late mortality and neurological events were similar between the BA and LA groups. Conclusion There was no significant difference in the rate of restored sinus rhythm, the risk of death, and cerebrovascular events between BA and LA, but BA had a higher rate of permanent pacemaker implantation.

Atrial appendages’ mechanics assessed by 3D transoesophageal echocardiography as predictors of atrial fibrillation recurrence after pulmonary vein isolation

“…This could be due to the fact that although the right atrium plays a role in the pathophisiology of atrial fibrillation, it is in much lesser extent compared with the left atrium, and we did not do any ablation in the anatomical right atrium, consequently there is a lower contribution of the RAA in the atrial contraction in comparison to LAA contribution to LA contraction after PVI [27] , [28] . There are no similar studies to compare our results with, however, there are studies that highlight the role of the right atrium in the pathophysiology of AFR after ablation [27] , [28] . One of the mechanisms is the SVC arrhythmogenicity, which is one of the main sources of non-pulmonary vein ectopies that initiate AF.…”

Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta‐analysis of clinical studies with a focus on the causes of pacemaker implantation

“…This meta‐analysis is currently the largest study evaluating the efficacy and safety of BA vs LA approach for concomitant AF ablation during cardiac surgery, involving 7065 patients from 28 studies published up to November 2018: the most recent meta‐analysis on a similar topic included 3609 patients from 21 studies up to August 2016 . That study evidenced for the BA group higher prevalence of sinus rhythm at 6 months only and higher permanent implantation rates.…”

Comparative characteristics of biatrial and left atrial ablation in surgical treatment of long-standing persistant atrial fibrillation in patients with concomitant disease

“…В одном сравнительном метаанализе, наоборот, были продемонстрированы неутешительные результаты, а именно БА оказалась неэффективной в восстановлении синусового ритма в сравнении с изолированной ЛА. Кроме того, риск смерти и цереброваскулярных событий значительно различался в группах БА и ЛА, но БА ассоциировалась с более высокой частотой имплантации постоянного водителя ритма [51]. Еще одно ретроспективное исследование показало неэффективность процедуры БА и повышенную частоту имплантаций кардиостимулятора [38].…”

“…Также 30-дневная, поздняя смертность и неврологические события были сопоставимы в группах. Однако через 6 мес синусовый ритм у пациентов в группе БА встречался чаще, чем в группе ЛА, при этом частота имплантаций постоянного ЭКС также была выше в группе БА [51].…”