Impact of the left common ostium following pulmonary vein isolation in AF: Systematic review and meta-analysis

Abstract

Purpose: Pulmonary vein isolation (PVI) through catheter ablation is the basis for the treatment of atrial fibrillation (AF). The left common ostium (LCO) is a high prevalence anatomical variation and has conflicting results in the effects on the prognosis following ablation. We undertook a systematic review and meta-analysis of studies that compared the arrhythmia recurrence rate after radiofrequency ablation or cryoablation balloon between patients with normal pattern pulmonary vein and patients with LCO. Methods and Results: Results were pooled using a fixed or random effect, at the discretion of heterogeneity (>25%), in addition, we associated subgroup analysis in these cases and when clinically indicated. Fourteen non-randomized studies totaling 3278 patients were included. In analyses using the two energies all patients: OR 1.01 (95% CI 0.84–1.23; P =.90, I2 = 67%) and excluding patients with any type of persistent AF (PeAF) and those submitted to linear atrial lesion (LAL) OR 0.80 (95% CI 0.52–1.22; P =.30, I2 = 71%). Using CRYO: all patients OR 1.34 (95% CI 1.03–1.74; P =.03, I2 = 0%). Using RF: all patients—OR 0.55 (95% CI 0.32–0.95; P =.03, I2 = 49%); excluding studies with long duration PeAF and the performance of LAL concomitant—OR 0.45 (95% CI 0.23–0.91; P =.03, I2 = 44%). Conclusion: The results suggest a better prognosis in patients with LCO, submitted to PVI without additional LAL under RF energy in paroxysmal AF and short-duration PeAF. In patients undergoing CRYO, the presence of LCO suggests a worse prognosis.