Effect of catheter ablation versus antiarrhythmic drugs on atrial fibrillation: A meta-analysis of randomized controlled trials

Abstract

Abstract. The aim of the present study was to compare the health outcomes of catheter ablation therapy against those of antiarrhythmic drugs (AADs) in the management of atrial fibrillation (AF). The effects of catheter ablation and AADs on a number of parameters were compared, including AF recurrence, all-cause mortality, stroke/transient ischemic attack (TIA) and quality of life (QoL). A systematic literature search of PubMed, Embase and the Cochrane Central Register of Controlled Trials was conducted to obtain relevant randomized controlled trials. The relative risks (RRs) and 95% confidence intervals (CIs) of AF recurrence, all-cause mortality and stroke/TIA between catheter ablation and AADs were subsequently calculated. Weighted mean differences (WMDs) and 95% CIs were used to evaluate the QoL between the two therapy groups. In total, 11 randomized trials, which included 1,763 AF patients, were eligible for the meta-analysis. Overall, the results indicated that catheter ablation produces superior outcomes compared with AADs in reducing AF recurrence (RR, 0.47; 95% CI, 0.38-0.58; P<0.001) and improving the QoL (physical component summary: WMD, 2.23; 95% CI, 0.24-4.21; P= 0.03; mental component summary: WMD, 2.69; 95% CI, 0.04-5.35; P= 0.05). However, no statistically significant difference was identified between the two groups with regard to the incidence of all-cause mortality (RR, 0.87; 95% CI, 0.37-2.06; P= 0.76) and stroke/TIA (RR, 1.83; 95% CI, P=0.20). In summary, catheter ablation was demonstrated to markedly reduce AF recurrence and improve QoL when compared with AAD therapy. However, the incidence rates of all-cause mortality and stroke/TIA were comparable between catheter ablation and AAD therapy.

Atrial fibrillation in women: treatment

“…Selection of appropriate patients is a complex process that requires careful consideration of clinical factors including symptoms, presence of heart disease, obesity, sleep apnoea, left atrial size, duration of persistent AF, and patient preferences 44 . A few large administrative registries have reported that, after multivariable adjustments, women are less likely to undergo catheter ablation than men 34,45 , and that women are underrepresented in catheter ablation meta-analyses 46–49 . A review on the association between sex and outcomes of catheter ablation for AF has also reported that women are referred less often and later than men 50 .…”

Atrial Structure and Function and its Implications for Current and Emerging Treatments for Atrial Fibrillation

“…Given that CA is an established treatment for AF with efficacy consistently superior to medical therapy, 36,37 an overview of the procedure is warranted. The cornerstone of the AF ablation is electrical isolation of the PVs by the targeted deployment of radiofrequency (essentially heat energy) ablation (RFA) lesions around the PV Ostia; CA is performed percutaneously via endovascular catheters.…”

Evaluation of the effect of prior antiarrhythmic drug use on the success of atrial fibrillation catheter ablation

“…Differences in ablation success rates reported in clinical trials are attributable to variables such as AF classification, concomitant risk factors and the definition of success . The AADs most often used in these trials include amiodarone, sotalol, dofetilide and flecainide.…”

“…The AADs most often used in these trials include amiodarone, sotalol, dofetilide and flecainide. Suppressive antiarrhythmic drugs were commonly used for the first 1‐3 months post‐ablation and the majority of the trials followed patients for 1‐year post‐procedure . It is common for AF to preclude recurrences occurring in the 3‐month “blanking” period following the procedure due to high rates of early recurrences that may not correlate with long‐term clinical success .…”