Catheter ablation in patients with paroxysmal atrial fibrillation and absence of structural heart disease: A meta-analysis of randomized trials

Parlavecchio, Antonio; Vetta, Giampaolo; Coluccia, Giovanni; Pistelli, Lorenzo; Caminiti, Rodolfo; Ajello, Manuela; Magnocavallo, Michele; Dattilo, Giuseppe; Foti, Rosario; Carerj, Scipione; Crea, Pasquale; Accogli, Michele; Chierchia, Gian Battista; de Asmundis, Carlo; Della Rocca, Domenico Giovanni; Palmisano, Pietro

doi:10.1016/j.ijcha.2023.101292

Cited by 1 publication

(1 citation statement)

References 29 publications

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“…Prior studies and meta-analyses suggest catheter ablation may afford greater freedom from AF recurrence compared with AADs in paroxysmal AF, but its role in persistent AF remains less defined [ 12 , 13 ]. However, few studies directly compare contemporary ablation approaches to next-generation AADs [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Antiarrhythmic drug therapy and catheter ablation in patients with paroxysmal or persistent atrial fibrillation: a systematic review and meta-analysis

Chander,

Kumari,

Luhana

et al. 2024

BMC Cardiovasc Disord

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Background Catheter ablation and antiarrhythmic drug therapy are utilized for rhythm control in atrial fibrillation (AF), but their comparative effectiveness, especially with contemporary treatment modalities, remains undefined. We conducted a systematic review and meta-analysis contrasting current ablation techniques against antiarrhythmic medications for AF. Methods We searched PubMed, SCOPUS, Cochrane CENTRAL, and Web of Science until November 2023 for randomized trials comparing AF catheter ablation with antiarrhythmics, against antiarrhythmic drug therapy alone, reporting outcomes for > 6 months. Four investigators extracted data and appraised risk of bias (ROB) with ROB 2 tool. Meta-analyses estimated pooled efficacy and safety outcomes using R software. Results Twelve trials (n = 3977) met the inclusion criteria. Catheter ablation was associated with lower AF recurrence (relative risk (RR) = 0.44, 95%CI (0.33, 0.59), P ˂ 0.0001) and hospitalizations (RR = 0.44, 95%CI (0.23, 0.82), P = 0.009) than antiarrhythmic medications. Catheter ablation also improved the physical quality of life component score (assessed by a 36-item Short Form survey) by 7.61 points (95%CI -0.70-15.92, P = 0.07); but, due to high heterogeneity, it was not statistically significant. Ablation was significantly associated with higher procedural-related complications [RR = 15.70, 95%CI (4.53, 54.38), P < 0.0001] and cardiac tamponade [RR = 9.22, 95%CI (2.16, 39.40), P = 0.0027]. All-cause mortality was similar between the two groups. Conclusions For symptomatic AF, upfront catheter ablation reduces arrhythmia and hospitalizations better than continued medical therapy alone, albeit with moderately more adverse events. Careful patient selection and risk-benefit assessment are warranted regarding the timing of ablation.

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Section: Introductionmentioning

confidence: 99%