Objective      To compare the efficacy and safety of pulmonary vein isolation (PVI) versus PVI plus adjunctive ablation of complex fractionated atrial electrograms (CFAEs) in patients with atrial fibrillation (AF) after a single procedure.       Methods      Literature search was conducted in PubMed

EMBASE

Cochrane Library

CBM

Elsevier

CNKI and VIP for the clinical controlled trials of PVI versu

s PVI plus adjunctive ablation of CFAEs in patients with AF

from January 1

1980 to August 31

2012. The references in the included literature were also retrieved. The extracted data were analyzed using RevMan 5.1 software.       Results      Twelve qualified trials involving 1 131 AF patients were included. The results of meta-analysis showed that: in an overall pooled estimation

compared with PVI alone

the rates of sinus rhythm maintenance (RR=1.17

95% CI=1.04 to 1.32

P

=0.008) were increased by PVI plus adjunctive ablation of CFAEs. Subgroup analysis demonstrated that PVI plus adjunctive ablation of CFAEs increased the rates of sinus rhythm maintenance in paroxysmal AF (RR=1.12

95% CI=1.01 to 1.24

P

=0.03) and persistent AF (RR=1.32

95% CI=1.14 to 1.53

P

=0.000 3). Adjunctive ablation of CFAEs significantly increased mean procedural

mean fluoroscopy

and mean radiofrequency (RF) application time. The incidence of complications was not significantly different between the two groups (

P

=0.85).       Conclusion      PVI followed by adjunctive ablation of CFAEs increases the rate of long-term sinus rhythm maintenance in patients. Adjunctive ablation of CFAEs increases procedural

fluoroscopy

and RF application time. The risk/benefit profile of adjunctive ablation of CFAEs needs further evaluation with additional studies and long-term follow-up.