Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation: Meta-analysis of Safety and Efficacy

Abstract

Background: Radiofrequency ablation (RFA) and antiarrhythmic drugs (AADs) are the main treatments used for atrial fibrillation (AF). In recent years, a number of articles comparing the 2 treatments have begun to emerge. Though, the influence of follow-up time in the meta-analysis was not considered in these articles. However, more recently, large-scale clinical trial articles have included follow-up with the patients up to 5 years after treatment. Therefore, the aim of this study was to assess the impact of variable follow-up times on the recurrence of AF by observing both the short-term and long-term efficacy and safety of catheter ablation and AADs for the treatment of AF. Methods and Results: The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random effect summary estimates were calculated as standardized mean differences and odds ratios with 95% confidence intervals for continuous and binary outcomes. In this study, 9 randomized controlled trials (n = 1542 patients) were included. The rate of recurrence of AF with no limit on follow-up time, >12 months, >18 months, >24 months, >30 months, and approximately 36 months was compared. Furthermore, the gap between the RFA and AAD groups in the recurrence rate of AF was found to decrease inversely to follow-up time. When the follow-up time reached 24 months, the difference between RFA and AAD was relatively stable with an odds ratio of 0.45 (95% confidence interval: 0.32–0.62). Overall, RFA decreased adverse events in the remaining trials; however, AAD performed better in terms of safety and had fewer adverse events with RFA usually causing more serious complications. Conclusion: RFA is more advantageous in terms of recurrence rate of AF than drug therapy. In addition, the analysis suggests that this effect persists during long-term follow-up; however, these benefits appear to decrease with longer follow-up time. Finally, AAD performed better in terms of safety and had fewer adverse events.

Iatrogenic Infective Endocarditis With Septic Emboli: An Unusual Complication of Intracardiac Manipulation

“…Although there are several documented complications of RFA like pulmonary venous thrombosis, pulmonary venous stenosis, left atrial hematoma, etc., AEF is considered to be one of the most dreadful and fatal complications of RFA [ 6 ]. The first documented case of AEF as a complication of RFA was described in the year 2004 by Pappone et al [ 7 ].…”

Nano drugs delivery system: A novel promise for the treatment of atrial fibrillation

“…Classic antiarrhythmic drug treatment not only has poor curative effects and a high recurrence rate, but will also inevitably produce toxic side effects after long-term use ( 38 , 39 ). Although there are various ablation strategies in the clinical practice of AF treatment, in general, neither endocardial catheter ablation nor surgical ablation has achieved satisfactory results in the success rate of AF elimination ( 3 , 40 – 45 ), and there is a significant learning curve; experienced medical centers are far more effective than those with fewer deployments ( 46 , 47 ). The CABANA trial showed that 36.4% of catheter ablation patients experienced recurrence of AF within 12 months after surgery, and 18.4% of catheter ablation patients developed symptomatic AF throughout follow-up ( 48 ).…”

Two-year outcomes of pulmonary vein isolation and cava-tricuspid isthmus radiofrequency ablation vs pharmacological only antiarrhythmic therapy: a single center experience

“…Radiofrequency ablation (RFA) is one of the leading approaches to rhythm control in atrial re-entry arrhythmias. It is a first-choice treatment tactic in symptomatic and high-risk atrial flutter and often prescribed to atrial fibrillation (AF) patients with drug inefficiency or intolerance [1,2]. RFA -isolation of pulmonary veins for AF and RFA of cava-tricuspid isthmus in right atria for flutter treatment could be used alone or simultaneously to increase the efficiency of a single procedure [3,4].…”