Efficacy of selective arrhythmogenic pulmonary veins isolation versus empirical all pulmonary veins isolation for atrial fibrillation: a meta-analysis of randomized and observational studies

Purpose Several clinical trials showed inconsistent results of the effect of isolating all versus arrhythmogenic pulmonary veins (PVs) on long-term control of atrial fibrillation (AF). We hypothesized that isolation of arrhythmogenic veins had a comparable success rate to the empiric isolation of all PVs. Methods PUBMED, EMBASE, and the Cochrane Library were searched for randomized controlled trials and nonrandomized, observational studies. The efficacy and adverse events of isolating all versus arrhythmogenic PVs were presented as risk ratio (RR) with 95 % confidence intervals (CIs), and weighted mean differences and 95 % CIs were calculated to compare the procedure time and fluoroscopic time between the isolation all PVs and arrhythmogenic PVs. Results Six trials with 658 patients were included in the analysis. Isolation of arrhythmogenic PVs was as efficacious as empiric isolation of all PVs in achieving long-term AF control (RR, 0.96; 95 % CI, 0.87–1.05; p = 0.36). Isolation of arrhythmogenic PVs group had shorter procedure time, fluoroscopic time and fewer adverse events than the isolation of all PVs group. Conclusions The present analysis suggests that isolation of arrhythmogenic veins had a comparable long-term success rate, shorter procedure time, fluoroscopic time, and fewer adverse events than the empiric isolation of all PVs.