Posterior wall isolation is associated with increased freedom from all atrial tachyarrhythmias and atrial fibrillation

Abstract 2301974, presented at Western Atrial Fibrillation Symposium 2026

Posterior wall isolation (PWI), an adjunctive therapy to pulmonary vein isolation (PVI) in de novo and redo atrial fibrillation (AF) catheter ablations, remains controversial. We conducted a meta-analysis to elucidate outcomes of PWI.An unrestricted literature search of Ovid MEDLINE, Embase, and Web of Science identified studies on PWI and PVI in AF catheter ablation as compared to PVI alone. Energy sources of catheter ablation included radiofrequency ablation, cryoablation, and pulsed field ablation. The primary endpoint was recurrence of all atrial tachyarrhythmias (AF, atrial tachycardia, or atrial flutter). Secondary endpoints included recurrence of AF alone, procedural time, and procedural complication rates (vascular access, bleeding, stroke, pericardial effusion/tamponade, atrioesophageal fistula, bradyarrhythmias requiring pacing, pulmonary vein stenosis, phrenic nerve palsy, heart failure, and myocardial infarction).Twenty-one studies with 4,546 patients (2,052 with PWI and PVI, 2,494 with PVI alone) were included. Mean follow-up time was 15.7 months, mean age was 64.4 years, 28.5% of patients were women, mean left ventricular ejection fraction was 56.7%, mean LA diameter was 44.6 millimeters, and mean CHA2DS2-VASc score was 2.3. Compared to PVI alone, PWI and PVI was associated with increased freedom from atrial tachyarrhythmias (OR 0.65, 95% CI 0.48-0.88, p< 0.01), increased freedom from AF (OR 0.45, 95% CI 0.30-0.67, p< 0.001), and longer procedural times (mean difference 27.1 minutes, 95% CI 14.8-39.3, p< 0.001). There was no difference in procedural complications rates (OR 1.11, 95% CI 0.78-1.57, p=0.57).PWI in AF catheter ablation was associated with increased freedom from atrial tachyarrhythmias, increased freedom from AF, and longer procedures--with neutral effect on procedural complication rates.