The role of left atrial appendage isolation in catheter ablation of atrial fibrillation: a meta-analysis

Abstract

Background. Pulmonary vein isolation is the main method of atrial fibrillation treatment, but it does not lead to effective outcomes in persistent atrial fibrillation, prompting investigation of other arrhythmogenic substrates, such as left atrial appendage (LAA) isolation. The efficacy of this approach remains unclear. Objective(s). To evaluate the efficacy of left atrial appendage isolation in addition to pulmonary vein isolation, compared to pulmonary vein isolation alone, in terms of AF recurrence, embolisms and complications. Materials and methods. We conducted a systematic meta-analysis of clinical studies from PubMed, Embase, and the Cochrane Library. Nine studies (4 RCTs, 5 observational) including 2,847 patients with persistent AF were analyzed. Patients were treated with pulmonary vein isolation plus LAA isolation versus pulmonary vein isolation alone using standard procedures. Results. Primary 12-month analysis showed a significant reduction in atrial arrhythmia recurrence in patients undergoing left atrial appendage isolation (OR: 1.84; 95% CI: 1.56– 2.18; p<0.005). Due to high heterogeneity (I² ≈ 90%), a random-effects model was applied, which showed a statistically non-significant trend (OR: 1.70; 95% CI: 0.96–3.01; p=0.07). The systemic embolism rate was not statistically significant: 3.1% in the left atrial appendage isolation group vs. 1.8% in the standard isolation group (OR: 1.84; 95% CI: 0.59– 4.98; p=0.30). Complications and ionizing radiation exposure time were comparable between groups. Conclusion(s). At 12-month follow-up, freedom from atrial arrhythmias was higher in patients undergoing left atrial appendage isolation compared to standard ablation, without an increase in procedural complications or stroke. However, additional studies in homogeneous populations are needed.