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.
