Catheter Ablation Versus Medical Therapy for Atrial Fibrillation

Abstract

Background: Despite the publication of several randomized clinical trials comparing catheter ablation (CA) with medical therapy (MT) in patients with atrial fibrillation (AF), the superiority of one strategy over another is still questioned by many. In this meta-analysis of randomized controlled trials, we compared the efficacy and safety of CA with MT for AF. Methods: We systematically searched MEDLINE, EMBASE, and other online sources for randomized controlled trials of AF patients that compared CA with MT. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular hospitalizations and recurrence of atrial arrhythmia. Subgroup analyses stratified by the presence of heart failure with reduced ejection fraction, type of AF, age, and sex were performed. Risk ratios (RRs) with 95% CIs were calculated using a random effects model, and Mantel-Haenszel method was used to pool RR. Results: Eighteen randomized controlled trials comprising 4464 patients (CA, n=2286; MT, n=2178) were included. CA resulted in a significant reduction in all-cause mortality (RR, 0.69; 95% CI, 0.54–0.88; P =0.003) that was driven by patients with AF and heart failure with reduced ejection fraction (RR, 0.52; 95% CI, 0.35–0.76; P =0.0009). CA resulted in significantly fewer cardiovascular hospitalizations (hazard ratio, 0.56; 95% CI, 0.39–0.81; P =0.002) and fewer recurrences of atrial arrhythmias (RR, 0.42; 95% CI, 0.33–0.53; P <0.00001). Subgroup analyses suggested that younger patients (age, <65 years) and men derived more benefit from CA compared with MT. Conclusions: CA is associated with all-cause mortality benefit, that is driven by patients with AF and heart failure with reduced ejection fraction. CA reduces cardiovascular hospitalizations and recurrences of atrial arrhythmia for patients with AF. Younger patients and men appear to derive more benefit from CA.

Silent strokes after thoracoscopic epicardial ablation and catheter ablation for atrial fibrillation: not all lesions are permanent on follow-up magnetic resonance imaging

“…The treatment of AF consists of antiarrhythmic drug therapy or ablation procedures, mainly catheter-based pulmonary venous isolation. Catheter-based pulmonary venous isolation has been shown to be superior to treatment by antiarrhythmic drugs in randomized studies (7). However, the efficacy of catheter ablation in patients with the non-paroxysmal form of AF remains limited.…”

Meta-analysis of medical management versus catheter ablation for atrial fibrillation

“…All the RCTs included in our analysis were of high methodological quality. Because recent metaanalyses have only assessed AF patients with HF (Asad et al, 2019;Chen et al, 2019;Ruzieh et al, 2019;Virk et al, 2019), we included studies that enrolled AF patients without HF and with AHF. In ad- Fig.…”

Effect of family history of atrial fibrillation on recurrence after atrial fibrillation ablation: A report from the Chinese Atrial Fibrillation Registry Study

“…Patients with atrial fibrillation (AF) are at an increased risk of stroke, heart failure, mortality, 1 and impaired quality of life 2 . Percutaneous catheter ablation, as compared with antiarrhythmic drugs, is a more effective rhythm control therapy for patients with AF 3 . However, the risk of postablation atrial tachyarrhythmia (AT) recurrence remains high and repeated interventions are frequently indicated 4…”