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Introduction:Many studies report rates of complete freedom from atrial fibrillation (AF) after AF ablation procedure. AF burden reduction post AF ablation is a very meaningful end-point but is less often reported. We sought to quantify average reduction in atrial fibrillation burden after PVI by conducting a meta-analysis of published studies.Hypothesis:AF burden reduction rates after AF ablation is an important end point and is relatively similar amongst published studies.Methods:We included patients (n=1016) enrolled in 14 studies published before May, 2019 in which pulmonary vein isolation (PVI) ablation was performed for AF, where pre-ablation and follow-up AF burdens were quantified by a wearable monitor or cardiovascular implantable electronic device. Patients with paroxysmal AF or persistent AF were included. Using a standard protocol, information on sample size, study design, time to follow-up after ablation, publication journal, and burden of AF before and after ablation were abstracted independently by the investigators.Results:Average AF burden (defined as a percentage of hours in each day) was 28% prior to PVI and 5% after PVI (p=0.006), with a mean burden reduction of 77% (SD+/- 15%). Pre-ablation maximum burden was 100%, and post ablation maximum was 18%. 4 studies (51% of patients) were randomized, and all published in journals more frequently cited (by SCImago Journal Rank indicator) than the other 8 non-randomized studies (49% of patients). There was no significant difference in the mean reduction in AF burden between the randomized and non-randomized patient groups (76% vs. 79%, p=0.75).Conclusions:AF burden reduction post-ablation is consistent, with a mean reduction of 77%, irrespective of randomization. Further investigation could identify factors leading to greater reduction in AF burden.

Background:Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are two alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. It has been noted that substantial differences in clinical characteristics between patients referred for CAS vs. CEA may preclude direct comparisons of effectiveness. We sought to rigorously examine the clinical profiles of patients referred for CAS vs. CEA.