Catheter ablation significantly reduced recurrent atrial arrhythmia compared to antiarrhythmic drugs (RR 0.51; 95% CI 0.42-0.63; P<0.00001) over a median 12-month follow-up.
Meta-Analysis (n=3,725)
Does catheter ablation improve freedom from recurrent atrial arrhythmia and reduce mortality compared to antiarrhythmic drugs in adults with atrial fibrillation?
Catheter ablation is superior to antiarrhythmic drugs for managing atrial fibrillation, significantly reducing arrhythmia recurrence and mortality over 12 months without increasing serious adverse events.
Effect estimate: RR 0.51 (95% CI 0.42-0.63)
p-value: p=<0.00001
Abstract This meta-analysis compares the efficacy and safety of catheter ablation with antiarrhythmic therapy for atrial fibrillation (AF) in randomized controlled trials (RCTs) We systematically searched PubMed, Web of Science, Google Scholar, Embase, and Cochrane Library for RCTs published in English. Studies comparing catheter ablation (radiofrequency or cryoablation) with antiarrhythmics for rate or rhythm control in adults with AF were included. Data were independently extracted by two investigators. The quality of evidence was assessed using GRADE analysis. 18 RCTs involving 3725 patients were included. The overall risk of bias was adjudicated to be “low.” On meta-analysis, catheter ablation significantly increased the likelihood of being free from recurrent atrial arrhythmia, with a 49% reduction rate over a median follow-up of 12 months (RR: 0.51; 95% CI: 0.42–0.63; P < 0.00001). The risk of developing serious adverse events was similar in patients undergoing catheter ablation or receiving antiarrhythmics (RR: 0.88; 95% CI: 0.77–1.01; P = 0.06). However, the mortality risk over a median follow-up of 12 months was higher in patients with AF receiving antiarrhythmic drugs than in those undergoing catheter ablation (RR: 0.74; 95% CI: 0.58–0.94; P = 0.01). The evidence was found to be of “high” quality on GRADE analysis. It was concluded that catheter ablation is more effective than antiarrhythmic drugs in managing AF due to a lower risk of recurrence. Although it has a similar likelihood of serious adverse effects, the mortality risk is lower over a median follow-up of 12 months.
Garg et al. (Sun,) conducted a meta-analysis in Atrial fibrillation (n=3,725). Catheter ablation vs. Antiarrhythmic drugs was evaluated on Recurrent atrial arrhythmia (RR 0.51, 95% CI 0.42-0.63, p=<0.00001). Catheter ablation significantly reduced recurrent atrial arrhythmia compared to antiarrhythmic drugs (RR 0.51; 95% CI 0.42-0.63; P<0.00001) over a median 12-month follow-up.
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