![]() Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014. The statistical analysis was performed by the Review Manager (RevMan) Version 5.3. Funnel plot analysis was used to address publication bias. Random effects models for analyses were used with high heterogeneity (defined as I 2 > 25%) otherwise, fixed effects models of DerSimonian and Laird were used. Heterogeneity of effects was evaluated using the Higgins I-squared ( I 2) statistic. The Mantel-Haenszel methods are the fixed-effect methods used when event rates are low or study size is small, as the estimates of the standard errors of the effect estimates that are used in the inverse variance methods may be poor. Discrepancies were resolved by discussion or adjudication by a third author (J.C.H.).ĭata was summarized across treatment arms using the Mantel-Haenszel risk ratio (RR), inverse variance mean difference (MD). and O.M.A.) independently assessed the risk of bias of the included trials using standard criteria defined in the Cochrane Handbook for Systematic Reviews of Interventions. ![]() and O.M.A.) independently assessed the quality items and discrepancies were resolved by consensus or involvement of a third reviewer (J.C.H), if necessary. Disagreements were resolved by consensus. Information was gathered using standardized protocol and reporting forms. Outcomes were extracted from original manuscripts and supplementary data. and O.M.A.) independently performed literature search and extracted data from eligible studies. We aimed to compare the efficacy and safety between LAAW and LMI lines. The studies had to fulfill the following criteria to be considered in the analysis: (1) Studies had to have compared outcomes in patients who underwent ablation with LAAW versus LMI lesion sets (2) Studies had to have compared and reported rates of achieving bidirectional block, ablation times, ablation line length, LAA activation delay, rates of pericardial effusions, and/or maintenance of sinus rhythm (3) Studies must have been published in a peer-reviewed scientific journal. The PRISMA statement for reporting systemic reviews and meta-analyses was applied to the methods for this study. Studies were selected by two independent reviewers. Search terms included ( Mitral Annular Flutter OR Atrial Fibrillation) and ( Mitral Isthmus Ablation or Anterior Mitral Ablation) and ( Catheter Ablation). The reference list of all eligible studies was also reviewed. We searched PubMed,, Medline, Google Scholar, and the Cochrane Central Register of Clinical Trials (Cochrane Library, Issue 09, 2017). However, LAAW ablation required a longer ablation line length, resulted in greater LAA activation delayed and was associated with more sinus rhythm maintenance, with the added advantage of avoiding ablation in the CS. ![]() ConclusionĪblation of mitral annular flutter with a LAAW line compared to a LMI line showed no difference in rates of acute bidirectional block, ablation time, or pericardial effusion. There was no significant difference in pericardial effusions (RR 0.36 95% CI, 0.39–20.75) between groups and more patients were maintained sinus rhythm (RR 1.19 95% CI, 1.03–1.37, p = 0.02) who underwent LAAW compared to LMI. There were no significant differences in bidirectional block (RR 1.26 95% CI, 0.94–1.69) or ablation time (MD −1.5 95% CI, −6.11–3.11), but LAAW ablation was associated with longer ablation line length (MD 11.42 95% CI, 10.69–12.14) and longer LAA activation delay (MD 67.68 95% CI, 33.47–101.89.14) when compared to LMI. In the LMI ablation group, 40% of patients required CS ablation. Resultsįour studies with a total of 594 patients were included, one of which was a randomized control trial. Risk ratio (RR) and mean difference (MD) 95% confidence intervals were measured for dichotomous and continuous variables, respectively. We performed a systematic review for all studies that compared LAAW versus LMI lines. We sought to compare the efficacy and safety of catheter ablation utilizing either a left atrial anterior wall (LAAW) line or a lateral mitral isthmus (LMI) line. Mitral annular flutter (MAF) is a common arrhythmia after atrial fibrillation ablation.
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