Catheter Ablation vs. Anti-Arrhythmic Drugs as First-Line Treatment in Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Frontiers in Cardiovascular Medicine
Andrea SagliettoMatteo Anselmino

Abstract

Background: Catheter ablation has become a well-established indication for long-term rhythm control in atrial fibrillation (AF) patients refractory to anti-arrhythmic drugs (AADs). Efficacy and safety of AF catheter ablation (AFCA) before AADs failure are, instead, questioned. Objective: The aim of the study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing first-line AFCA with AADs in symptomatic patients with paroxysmal AF. Methods: We performed a random-effects meta-analysis of binary outcome events comparing AFCA with AADs in rhythm control-naïve patients. The primary outcomes, also stratified by the type of ablation energy (radiofrequency or cryoenergy), were (1) recurrence of atrial tachyarrhythmias and (2) recurrence of symptomatic atrial tachyarrhythmias. The secondary outcomes included adverse events. Results: Six RCTs were included in the analysis. AFCA was associated with lower recurrences of atrial tachyarrhythmias [relative risk (RR) 0.58, 95% confidence interval (CI) 0.46-0.72], consistent across the two types of ablation energy (radiofrequency, RR 0.50, 95% CI 0.28-0.89; cryoenergy, RR 0.60, 95% CI 0.50-0.72; p-value for subgroup differences: 0.55). Similarly, AFC...Continue Reading

References

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Citations

Oct 30, 2021·Frontiers in Cardiovascular Medicine·Allan BohmStefan Farsky

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Software Mentioned

R Foundation for Statistical Computing
R
AF
PAF
FIRST
MANTRA
STOP
RAAFT
EARLY
Cochrane risk of bias 2 ( RoB

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