Holistic approach of ablation versus antiarrhythmic drugs for efficacy, safety, and quality of life improvement in rhythm control of atrial fibrillation: a meta-analysis of randomized trials

Abstract

Background/Introduction Recent studies have shown that catheter ablation (CA) is more superior compared to the usage of the antiarrhythmic drug (AAD) regarding its efficacy in decreasing the incidence of persistent and chronic atrial fibrillation (AF). However, choosing the right rhythm control strategy to provide holistic care for the patients should be individualized on each patients condition. Purpose In this meta-analysis, the author will compare both CA and AAD regarding their efficacy, safety, and their effect on the quality of life of AF patients. Methods The authors systematically searched the relevant journals throughout PubMed, Medline, and the Cochrane Library, with a range of publications from 2010 to 2021. The primary outcomes were AF recurrence, quality of life score, and adverse events. Secondary outcomes were the rehospitalization rate and all-cause mortality. Analysis was performed using a random-effects model with the Mantel-Haenszel method, and results are presented as 95% CIs. Results A total of 23 RCTs consisted of 10,316 patients were included. Although some adverse events (pericarditis, pleural effusions, and cardiac tamponade) were found in 2.8% population of the CA group (RR: 4.15; 95% CI: 1.65, 10.41; p=0.002), the CA group was found superior in suppressing the rate of AF recurrence (RR: 0.56; 95% CI: 0.48, 0.65; p<0.00001). Regarding the SF-36 Mental (p<0.00001) and Physical Assessment (p<0.0001), both CA and AAD showed increased quality of life post treatment compared with baseline level (pre-treatment) for each therapy. Following the interventions, the CA group significantly showed a lower rehospitalization rate (RR: 0.82; 95% CI: 0.70,0.97; p=0.02) and also showed a lessened mortality trend (6.84%) compared to the AAD group (9.01%) even though not statistically significant. Conclusion(s) Statistically, there is no difference for both groups in their capability of reducing the mortality rate. However, CA was found to be more superior in efficacy and reducing the number of rehospitalizations. Quality of life also significantly improve same as AAD, which further might be provide a holistic outcome of rhytm control. Funding Acknowledgement Type of funding sources: None.