Outcomes of catheter ablation versus antiarrhythmic therapy in patients with atrial fibrillation: a systematic review and meta-analysis

Deshpande, Radhika; Al‐Khadra, Yasser; Singanallur, Prashanth; Botchway, Albert; Labedi, Mohamed

doi:10.1007/s10840-022-01365-z

Cited by 8 publications

(3 citation statements)

References 47 publications

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“…Recently, The Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST-AFNET 4) trial looked at the effectiveness of an early rhythm-control strategy in patients who had recently been diagnosed with AF (enrolled median 36 days after AF diagnosis), Early rhythm control reduced the composite primary outcome of cardiovascular death, stroke, and hospitalization for worsening heart failure and acute coronary syndrome by 21% (from 5.0%/year to 3.9%/year) in this trial [32] .While AAD therapy has been definitively proven to be superior to placebo in the prevention of arrhythmia recurrence,but the young AF patient must accept a "lifetime" daily intake of AAD as part of a medical rhythm control plan, as well as the possibility of accumulative side effects, leading to high rates of withdrawn(OR 1.63-2.91) [33] . It's interesting to note that young patients had a rate of patients who needed particular AAD treatment and anticoagulant drugs even after catheter ablation that was substantially lower, showing that AF control is more likely to be achieved, this finding is consistent with the CHADS 2 and CHA 2 DS 2-VASc scores' predictions of a lower prevalence of comorbidities and thromboembolic events [34] .…”

Section: Discussionmentioning

confidence: 99%

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Zhan

Zheng

Huang

et al. 2023

Preprint

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Aims The differences in the clinical outcomes of rhythm and safety after catheter ablation in young and old atrial fibrillation(AF) patients remain unclear. The purpose of this study was to compare the clinical outcomes of catheter ablation for in young and old AF patients. Methods and results The Medline and EMBASE databases were searched for published articles up to Octomber 2022. Studies that met our predefined inclusion criteria were included. The primary endpoints were freedom from AF/atrial tachycardia (AT) recurrence, safety ouctcomes including the stroke/transient ischaemic attack (TIA), cardiac tamponade and pericardial effusion. After literature search and detailed assessment, 6 studies (9982 patients) were identified. Our analyses showed that the rate of freedom from AF/AT recurrence was higher in young than old AF patients after ablation [odds ratio (OR): 0.58, 95% confidence interval (CI) 0.36–0.92; P -0.02]. Compared to older patients, there were similar rate of adverse outcomes including pericardial effusion /tamponade (OR=0.61, 95%CI 0.29-1.27,P=0.18), hematoma(OR=1.87, 95%CI 0.62,5.63, P=0.27) and stroke/ TIA rate(OR=0.25, 95%CI 0.05,1.41, P=0.12) . Conclusions In younger atrial fibrillation patients, there is a lower major complication rate and a comparable efficacy rate, with a greater chance of being AF free without antiarrhythmic drugs. These findings suggest that it may be appropriate to consider ablative therapy as first-line therapy in this age group.

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Section: Discussionmentioning

confidence: 99%

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Zhan

Zheng

Huang

et al. 2023

Preprint

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“…However, AADs remain a treatment option for patients with contraindications for ablation or in those who prefer medical management. 4 b. Catheter Ablation: Successful ablation procedures have been associated with excellent long-term outcomes, with sustained freedom from AF achieved in approximately 60-70% of patients at 1-5 years of follow-up. Repeat ablations may be necessary in some cases.…”

Section: Introductionmentioning

confidence: 99%

Antiarrhythmic Drugs vs. Ablation for Atrial Fibrillation

Irfan

2023

Pak Heart J

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Summary: Atrial fibrillation (AF) is a common and potentially life-threatening cardiac arrhythmia that affects millions of individuals worldwide. The treatment landscape for AF has traditionally comprised antiarrhythmic drugs (AADs), which aim to restore and maintain normal heart rhythm. However, over the past two decades, catheter ablation has emerged as an alternative therapeutic approach in the management of AF. This article systematically compares the effectiveness, safety, and long-term outcomes of AADs and catheter ablation as treatment strategies for atrial fibrillation. Introduction: Atrial fibrillation (AF) is characterized by disorganized electrical activity in the atria, causing irregular and often rapid heart rhythm. Over the years, pharmacological therapy with antiarrhythmic drugs (AADs) has been the mainstay of AF treatment. Nonetheless, catheter ablation has gained significant momentum due to its ability to directly target the arrhythmogenic substrate within the heart.1 Efficacy: Antiarrhythmic Drugs: Various classes of AADs inhibit specific ion channels or receptors to normalize cardiac electrical conduction. While AADs can effectively restore sinus rhythm in many patients, their long-term success in maintaining sinus rhythm is modest, with recurrence rates ranging from 40% to 60% within one year.2 Catheter Ablation: Ablation procedures selectively target and destroy the abnormal electrical pathways contributing to AF. In well-selected patients, catheter ablation has demonstrated higher efficacy rates than AADs, particularly in paroxysmal AF, with success rates reaching 70-80% or more after a single procedure.2 Safety Profile: Antiarrhythmic Drugs: Although generally well-tolerated, AADs have notable adverse effects, including pro-arrhythmia, organ toxicity, and drug-drug interactions. These side effects often limit their usage or require careful patient monitoring.3 Catheter Ablation: While catheter ablation is generally safe, it has a finite risk of procedural complications, such as vascular injury, cardiac perforation, and stroke. Nonetheless, the overall complication rate is low, ranging from 1% to 5%, and is further decreasing with advancements in technology and operator experience.3 Quality of Life and Symptom Control: Antiarrhythmic Drugs: Effective rate control with AADs can significantly improve symptom burden and quality of life in patients with persistent or permanent AF.4 Catheter Ablation: Successful ablation procedures can offer long-term freedom from AF symptoms, eliminating or reducing the dependence on AADs and their associated side effects.4 Long-Term Outcomes: Antiarrhythmic Drugs: AAD therapy is often lifelong, and patients may require multiple medication adjustments due to loss of efficacy or intolerable side effects. However, AADs remain a treatment option for patients with contraindications for ablation or in those who prefer medical management.4 Catheter Ablation: Successful ablation procedures have been associated with excellent long-term outcomes, with sustained freedom from AF achieved in approximately 60-70% of patients at 1-5 years of follow-up. Repeat ablations may be necessary in some cases.4 Conclusion: While both antiarrhythmic drugs and catheter ablation have their advantages and disadvantages in the management of atrial fibrillation, catheter ablation has emerged as a promising treatment strategy, offering higher success rates and long-term symptom control compared to AADs. However, individual patient characteristics, preferences, and comorbidities should guide the selection of the optimal treatment approach, ensuring personalized and comprehensive management of atrial fibrillation. Further research is needed to refine patient selection criteria, improve ablation techniques, and optimize the use of antiarrhythmic drugs to enhance treatment outcomes for AF patients. References Asad ZUA, Yousif A, Khan MS, Al-Khatib SM, Stavrakis S. Catheter Ablation Versus Medical Therapy for Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Circ Arrhythm Electrophysiol. 2019;12(9):e007414. Andrade JG, Deyell MW, Macle L, Wells GA, Bennett M, Essebag V, et al. EARLY-AF Investigators. Progression of Atrial Fibrillation after Cryoablation or Drug Therapy. N Engl J Med. 2023;388(2):105-16. Charitakis E, Metelli S, Karlsson LO, Antoniadis AP, Rizas KD, Liuba I, et al. Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: a network meta-analysis. BMC Med. 2022;20(1):1-3. Deshpande R, AlKhadra Y, Singanallur P, Botchway A, Labedi M. Outcomes of catheter ablation versus antiarrhythmic therapy in patients with atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2022;65(3):773-802.

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“…[2][3][4][5][6] For these reasons, finding effective management strategies remains paramount.Over the decades, the management of AF has attempted to evolve to match the increasing understanding of the triggers for its initiation and perpetuation, with a heightened role of catheter-based ablative strategies. [7][8][9] While traditional focus has been on pulmonary vein isolation (PVI), more recent advanced approaches, including isolation of the posterior wall of the left atrium, ablation of the vein of Marshall (VoM), superior vena cava isolation, left atrial appendage isolation, rotor mapping and ablation, non-PV trigger ablation, scar homogenisation and other strategies, have been explored to limit recurrence in those with persistent forms of AF but with only incremental additional effectiveness compared with PVI alone in clinical studies. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] More recently, novel energy sources and mapping algorithms have also been explored for AF catheter ablation.…”

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confidence: 99%

Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation

Aksu

Skeete

Huang

2023

Arrhythm Electrophysiol Rev

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As the most common sustained arrhythmia, AF is a complex clinical entity which remains a difficult condition to durably treat in the majority of patients. Over the past few decades, the management of AF has focused mainly on pulmonary vein triggers for its initiation and perpetuation. It is well known that the autonomic nervous system (ANS) has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for AF. Neuromodulation of ANS – ganglionated plexus ablation, vein of Marshall ethanol infusion, transcutaneous tragal stimulation, renal nerve denervation, stellate ganglion block and baroreceptor stimulation – constitute an emerging therapeutic approach for AF. The purpose of this review is to summarise and critically appraise the currently available evidence for neuromodulation modalities in AF.

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Outcomes of catheter ablation versus antiarrhythmic therapy in patients with atrial fibrillation: a systematic review and meta-analysis

Cited by 8 publications

References 47 publications

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Antiarrhythmic Drugs vs. Ablation for Atrial Fibrillation

Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation

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