Curriculum in Cardiology
Mortality after catheter ablation for atrial fibrillation compared with antiarrhythmic drug therapy. A meta-analysis of randomized trials

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Introduction

Nonrandomized studies suggest a survival benefit for patients with atrial fibrillation (AF) undergoing catheter ablation compared with antiarrhythmic drug (AAD) therapy. Data from randomized trials are lacking. We performed a meta-analysis on mortality in randomized controlled trials comparing AF ablation with AADs.

Methods

Pubmed, the Cochrane Central Register of Controlled Trials, and abstracts of major conferences were searched for randomized trials comparing AF catheter ablation with AADs. Eight trials with a total of 930 patients were analyzed. Trial quality was assessed by a modified Jadad scale. Follow-up was 1 year in most trials. We assessed fixed effect risk differences (RDs) with the Mantel-Haenzel method, heterogeneity with I2 statistic, and publication bias with Begg's funnel plot and with Egger's test.

Results

A total of 7 deaths were reported: 3 in the ablation and 4 in the AAD arm. There was no difference in mortality between AF ablation and AAD therapy. The RD of mortality in all trials between patients randomized to ablation and those randomized to AADs was −0.003 (95% CI −0.018 to 0.013, P = .74) without evidence for heterogeneity (I2 = 0%, P = .907). No potential publication bias was found. There was also no difference in rates of stroke or transient ischemic attack between ablation and antiarrhythmic therapy for AF (RD = 0.004, 95% CI −0.010 to 0.018, P = .54).

Conclusion

This meta-analysis of randomized controlled trials showed similar survival of patients undergoing catheter ablation for AF compared with patients treated with AADs after 12 months of follow-up. There was also no difference in the rates of stroke or transient ischemic attack. These findings can be probably explained by the low-risk young populations who were included in the trials and the relatively short 12-month follow-up.

Section snippets

Search strategy and selection criteria

We performed a literature search in Pubmed and the Cochrane Central Register of Controlled Trials from January 2000 to January 2009 for randomized clinical trials that compared catheter ablation for AF with AAD therapy using the appropriate keywords “randomized,” “ablation,” “atrial fibrillation,” and “antiarrhythmic” without language restrictions. We additionally reviewed the reference lists of retrieved articles and searched the abstracts of the annual Scientific Sessions of the American

Results

The trial flow is shown in Figure 1. Eight randomized trials with a total of 930 randomized patients satisfying the inclusion criteria were identified and analyzed.10, 11, 12, 13, 14, 15, 16, 17, 18 One trial included patients with chronic AF,11 all other 7 trials included patients with paroxysmal10,12, 13, 14, 15, 16, 17, 18 or persistent AF,10, 13, 15, 16 with one of them being restricted to diabetic patients.15 Ablation was compared with AADs as first-line therapy in the study by Wazni et al

Discussion

In this meta-analysis of randomized controlled trials comparing catheter ablation with AAD therapy for AF, there was no difference in mortality or stroke/TIA rates between the 2 therapy forms.

This finding at first seems to contradict results from nonrandomized studies indicating an improved survival after AF ablation compared with medically treated AF patients.7 It also seems to contradict the expected effect of a method providing potentially curative treatment of a disease which is known to be

Disclosures

There are no financial or other interests that might pose a conflict of interest.

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