Limitations
The subpopulation of patients with persistent AF was under-represented (34%) in the pooled sample size, which may limit the applicability of the present findings in this group of patients. Data about patients with severely dilated LA (i.e. LAVi> 48ml/m2) are also lacking. Moreover, only a limited number of studies provided diagnostic accuracy analysis and performing such a meta-analysis to construct the pooled rock curve, to find the optimal cut off was impossible. Finally, PVI using cryoenergy was performed only in one study and, as a result, any possible confounding effect of this alternative procedure type could not be estimated.