Arq. Bras. Cardiol. 2025; 122(1): e20240472
Efficacy and Safety of Adjunctive Posterior Wall Isolation in Patients with Persistent Atrial Fibrillation: A Systematic Review and Meta-Analysis
João Vitor Levindo Coelho Novaes
, David de Pádua Brasil, Flavia Maria de Freitas Faria
, Isadora Soares Bicalho Garcia, Camila Ribeiro Pimenta
, Nathalia Sernizon Guimarães
, Marcus Vinicius Bolivar Malachias
This Original Article is referred by the Short Editorial "Does Posterior Wall Isolation in Catheter Ablation of Persistent Atrial Fibrillation Change Clinical Outcomes?".
Abstract
Background
In patients with persistent atrial fibrillation (AF), addition of posterior wall isolation (PWI) to pulmonary vein isolation (PVI) is controversial.
Objective
Compare PVI plus PWI versus PVI alone in patients with persistent AF.
Methods
We searched PubMed (by MEDLINE), Embase, LILACS, CENTRAL (by Cochrane Library), and Clinicaltrials.gov databases for randomized trials comparing PVI + PWI and PVI alone in persistent AF. The outcomes were: (i) AF recurrence; (ii) composite of recurrent atrial arrhythmias (i.e., AF, atrial tachycardia, or atrial flutter); (iii) major clinical complications (i.e., pericardial effusion or tamponade, sinus node dysfunction, or atrioesophageal fistula); (iv) mean ablation time. Risk of bias and quality of evidence were evaluated using the Cochrane Risk of Bias 2.0 tool and GRADE, respectively. Statistical significance was set at 5%, and subgroup and sensitivity analyses were performed.
Results
We included eight studies and 1119 patients, of which 561 underwent PVI + PWI. During follow-up (12 – 24 months), recurrence of AF was significantly reduced with adjunctive PWI (RR 0.66, 95% CI 0.44-0.98). Composite of recurrent atrial arrhythmias did not differ significantly (RR 0.83, 95% CI 0.65-1.06). Major clinical complications (RR 0.81, 95% CI 0.42-1.58) were similar, with PVI alone having a shorter mean procedure time (mean difference -23.37 minutes, 95% CI -30.23, -16.50).
Conclusion
Adjunctive PWI appears to be effective in improving recurrent AF, but not recurrence of all atrial arrhythmias. Procedure time was longer with PVI + PWI without significant change in overall safety. Further studies should focus on long-term benefit.
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