Abstract 4137350: Temporal Trends and Effect of Superior Vena Cava Isolation Plus Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation Ablation: A Systematic Meta-Analysis with Trial Sequential Analysis

Objectives: To assess the efficacy and safety of Superior Vena Cava Isolation (SVCI) plus Pulmonary Vein Isolation (PVI) compared to PVI alone in patients with drug-refractory paroxysmal atrial fibrillation (PAF). Methods: We utilized PubMed, EMBASE, Cochrane Library (CENTRAL) and Web of Science to identify the published randomized controlled trials (RCTs) involving patients undergoing SVCI+PVI ablation compared to PVI alone therapy. The search, conducted until February 17, 2024, used the terms "Superior Vena Cava," "Pulmonary Vein," "Radiofrequency Ablation," and "Atrial Fibrillation." Two reviewers screened records, extracted outcomes, and evaluated risk bias. The analysis employed Revman 5.4 and Trial Sequential Analysis (TSA 0.9.5.10 Beta). Results: The results included 4 RCTs involving 532 patients. Recurrence of atrial fibrillation significantly reduced in the SVCI+PVI group compared to the PVI alone group (RR 0.42, 95% CI 0.26–0.69, P = 0.0005; I 2 = 16%, P heterogeneity = 0.04) during a mean 12-month follow-up. Trial Sequential Analysis (TSA) supported these findings. Procedural complications did not show significant differences (RR 1.72, 95% CI 0.52–5.75, P = 0.38; I 2 = 0%, P heterogeneity = 0.56). Conclusion: In conclusion, the meta-analysis of RCTs suggests that SVCI in addition to PVI is superior to PVI alone for PAF, with no increase in procedural complications. TSA demonstrated consistent results with an adequate sample size, indicating no need for further RCTs on this matter.