Meta-Analysis of Catheter Ablation versus Medical Therapy in Patients with Atrial Fibrillation Without Heart Failure

Muhammad, Zia Khan; U, Khan Safi; Arshad, Adeel; Zarak, Muhammad Samsoor; Khan, Muhammad Shahzeb; Kaluski, Edo; Alkhouli, Mohamad

doi:10.4022/jafib.2266

Cited by 7 publications

(2 citation statements)

References 36 publications

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“…The population included in this trial was younger, with a lower CHA2DS2VASc score than that seen in the CABANA trial. Other meta-analyses failed to demonstrate statistically significant results regarding stroke events, as they needed more power [ 25 , 29 ]. The CABANA trial, even though being the largest of the studies, failed to show positive outcomes for the following reasons: a) reduced ‘true’ estimate effect due to high rate of crossovers and withdrawals, affecting the results of intention to treat analysis and b) background anticoagulation causing a lesser number of strokes in both arms [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Catheter ablation versus medical therapy in atrial fibrillation: an umbrella review of meta-analyses of randomized clinical trials

Titus,

Syeed,

Baburaj

et al. 2024

BMC Cardiovasc Disord

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This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.

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Section: Discussionmentioning

confidence: 99%

Catheter ablation versus medical therapy in atrial fibrillation: an umbrella review of meta-analyses of randomized clinical trials

Titus,

Syeed,

Baburaj

et al. 2024

BMC Cardiovasc Disord

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“…This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and followed the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria for assessment [10].…”

Section: Review Methodsmentioning

confidence: 99%

Treatment Outcomes of Catheter Ablation Versus Medical Therapy in Patients With Atrial Fibrillation: A Systematic Review

Karim,

Huang

2024

Cureus

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Atrial fibrillation (AF) management has witnessed a paradigm shift, with an increasing emphasis on rhythm control strategies. This systematic review aims to comprehensively assess and compare the efficacy and safety of catheter ablation versus medical therapy in the treatment of AF. A systematic search was conducted across major electronic databases, including PubMed, Embase, and the Cochrane Library, from inception to the present. Randomized controlled trials (RCTs) and observational studies comparing catheter ablation with medical therapy for AF were included. The primary outcomes included rhythm control success, recurrence rates, and adverse events. Secondary outcomes encompassed quality of life, hospitalization rates, and mortality. A total of six studies met the inclusion criteria, comprising 2,859 participants. Catheter ablation significantly improved rhythm control success compared to medical therapy. Subgroup analyses demonstrated variations in outcomes based on patient characteristics, procedural techniques, and follow-up durations. Recurrence rates favored ablation; however, ablation was associated with a higher incidence of minor complications and major adverse events. Catheter ablation demonstrates superior efficacy in achieving and maintaining rhythm control compared to medical therapy in the management of AF. Despite the increased risk of procedural complications, the overall safety profile remains acceptable. This systematic review provides valuable insights for clinicians and informs shared decision-making between patients and healthcare providers when choosing between catheter ablation and medical therapy for AF treatment.

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Impact of early ablation of atrial fibrillation on long-term outcomes: results from phase II/III of the GLORIA-AF registry

et al. 2022

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Background First-line ablation for atrial fibrillation (AF) reduces the risk of recurrent atrial arrhythmias compared to medical therapy. However, the prognostic benefit of early AF ablation remains undetermined. Herein, we aimed to evaluate the effects of early AF ablation compared to medical therapy. Methods Using data from phase II/III of the GLORIA-AF registry, we studied patients who were consecutively enrolled with newly diagnosed AF (< 3 months before baseline visit) and an increased risk of stroke (CHA2DS2–VASc ≥ 1). At baseline visit, 445 (1.7%) patients were treated with early AF ablation and 25,518 (98.3%) with medical therapy. Outcomes of interest were the composite outcome of all-cause death, stroke and major bleeding, and pre-specified outcomes of all-cause death, cardiovascular (CV) death, non-CV death, stroke and major bleeding. Results A total of 25,963 patients (11733 [45.2%] females; median age 71 [IQR 64–78] years; 17424 [67.1%] taking non-vitamin K antagonist oral anticoagulants [NOACs]) were included. Over a follow-up period of 3.0 (IQR 2.3–3.1) years, after adjustment for confounders, early AF ablation was associated with a significant reduction in the composite outcome of all-cause death, stroke and major bleeding (HR 0.50 [95% CI 0.30–0.85]) and all-cause death (HR 0.45 [95% CI 0.23–0.91]). There were no statistical differences between the groups in terms of CV death, non-CV death, stroke and major bleeding. Similar results were obtained in a propensity-score matched analysis of patients with comparable baseline variables. Conclusions Early AF ablation in a contemporary prospective cohort of AF patients who were predominantly treated with NOACs was associated with a survival advantage compared to medical therapy alone. Trial registration Clinical trial registration: http://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007 and NCT01937377. Graphical abstract Created with BioRender.com.

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Meta-Analysis of Catheter Ablation versus Medical Therapy in Patients with Atrial Fibrillation Without Heart Failure

Cited by 7 publications

References 36 publications

Catheter ablation versus medical therapy in atrial fibrillation: an umbrella review of meta-analyses of randomized clinical trials

Catheter ablation versus medical therapy in atrial fibrillation: an umbrella review of meta-analyses of randomized clinical trials

Treatment Outcomes of Catheter Ablation Versus Medical Therapy in Patients With Atrial Fibrillation: A Systematic Review

Impact of early ablation of atrial fibrillation on long-term outcomes: results from phase II/III of the GLORIA-AF registry

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