The efficacy of additional atrial driver ablation in persistent and long-standing persistent atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials.
6 affiliations
- 1Cardiology Research Office, Department of Cardiology and Vascular Medicine, Dr. Sardjito General Hospital, Yogyakarta, Indonesia. [email protected].
- 2Department of Cardiology and Vascular Medicine, Lawang General Hospital, Malang, Indonesia.
- 3Primaya Hospital PGI Cikini, Jakarta, Indonesia.
- 4Bachelor Study Program of Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.
- 5Amanah Medical Center, Banjarmasin, Indonesia. [email protected].
- 6Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University - Saiful Anwar General Hospital, Malang, Indonesia.
Abstract
Objective
Pulmonary vein isolation (PVI) remains the primary ablation strategy for atrial fibrillation (AF), yet its success in persistent (PeAF) and long-standing persistent AF (LS-PeAF) is suboptimal. Adjunctive ablation targeting atrial drivers has been proposed to enhance outcomes. This systematic review and meta-analysis compared PVI alone with PVI plus atrial driver ablation in PeAF and LS-PeAF.Methods
Comprehensive searches of PubMed, Scopus, Europe PMC, and Cochrane Library identified randomized controlled trials (RCTs) enrolling adults with PeAF or LS-PeAF undergoing first-time ablation. Eligible studies compared PVI alone versus PVI plus driver ablation and trials utilizing other adjunctive ablations were excluded. Outcomes included recurrence of AF and any atrial tachyarrhythmia (ATA) beyond the blanking period, procedural parameters, and complications. Pooled analyses employed random-effects models to measure risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).Results
Seven RCTs met inclusion criteria. Adjunctive driver ablation modestly improved freedom from AF (RR 1.16; 95% CI, [1.03, 1.31]; p = 0.01; I²=61%). However, this finding was accompanied by substantial heterogeneity and was not robust to leave-one-out sensitivity analysis. Driver ablation failed to elevate freedom from any ATA (RR 1.09; 95% CI, [0.98, 1.20]; p = 0.11; I²=47%). Procedure duration (MD 37.81 min; 95% CI, [4.42, 71.20]; p = 0.03; I²=96%), fluoroscopy time (MD 4.25 min; 95% CI, [2.83, 5.67]; p < 0.00001; I²=0%), and ablation time (MD 10.01 min; 95% CI, [0.25, 19.77]; p = 0.04; I²=95%) were significantly longer with adjunctive driver ablation. Procedural complication rates were comparable among both groups (RR 1.65; 95% CI, [0.80, 3.43]; p = 0.18; I²=20%).Conclusion
Additional atrial driver ablation modestly improves freedom from AF but does not reduce ATA recurrence, prolonging procedure time without increasing complications.
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BibTeX
@article{bramantyo2026efficacy,
title = {{The efficacy of additional atrial driver ablation in persistent and long-standing persistent atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials.}},
author = {Bernadus Bernardino Bramantyo and Dylan Hanny Firdaus and Juan Aditya and Agnes Vianne and Rizki Hari Mulia and Pirel Aulia Baravia and Ardian Rizal},
journal = {The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology},
year = {2026},
month = nov,
doi = {10.1186/s43044-026-00792-x},
url = {https://europepmc.org/article/MED/42970039},
note = {CC BY},
}
RIS
TY - JOUR
TI - The efficacy of additional atrial driver ablation in persistent and long-standing persistent atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials.
AU - Bernadus Bernardino Bramantyo
AU - Dylan Hanny Firdaus
AU - Juan Aditya
AU - Agnes Vianne
AU - Rizki Hari Mulia
AU - Pirel Aulia Baravia
AU - Ardian Rizal
PY - 2026
DA - 2026/11/02
JO - The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology
DO - 10.1186/s43044-026-00792-x
UR - https://europepmc.org/article/MED/42970039
AB - Objective Pulmonary vein isolation (PVI) remains the primary ablation strategy for atrial fibrillation (AF), yet its success in persistent (PeAF) and long-standing persistent AF (LS-PeAF) is suboptimal. Adjunctive ablation targeting atrial drivers has been proposed to enhance outcomes. This systematic review and meta-analysis compared PVI alone with PVI plus atrial driver ablation in PeAF and LS-PeAF.Methods Comprehensive searches of PubMed, Scopus, Europe PMC, and Cochrane Library identified randomized controlled trials (RCTs) enrolling adults with PeAF or LS-PeAF undergoing first-time ablation. Eligible studies compared PVI alone versus PVI plus driver ablation and trials utilizing other adjunctive ablations were excluded. Outcomes included recurrence of AF and any atrial tachyarrhythmia (ATA) beyond the blanking period, procedural parameters, and complications. Pooled analyses employed random-effects models to measure risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).Results Seven RCTs met inclusion criteria. Adjunctive driver ablation modestly improved freedom from AF (RR 1.16; 95% CI, [1.03, 1.31]; p = 0.01; I²=61%). However, this finding was accompanied by substantial heterogeneity and was not robust to leave-one-out sensitivity analysis. Driver ablation failed to elevate freedom from any ATA (RR 1.09; 95% CI, [0.98, 1.20]; p = 0.11; I²=47%). Procedure duration (MD 37.81 min; 95% CI, [4.42, 71.20]; p = 0.03; I²=96%), fluoroscopy time (MD 4.25 min; 95% CI, [2.83, 5.67]; p < 0.00001; I²=0%), and ablation time (MD 10.01 min; 95% CI, [0.25, 19.77]; p = 0.04; I²=95%) were significantly longer with adjunctive driver ablation. Procedural complication rates were comparable among both groups (RR 1.65; 95% CI, [0.80, 3.43]; p = 0.18; I²=20%).Conclusion Additional atrial driver ablation modestly improves freedom from AF but does not reduce ATA recurrence, prolonging procedure time without increasing complications.
SN - 1110-2608
SN - 2090-911X
ER -