Abstract 2759: Treatment of Atrial Fibrillation with Anti-arrhythmic Drugs or Radio Frequency Ablation: Two Systematic Literature Reviews and Meta-analyses
Introduction: The aim of the present study was to systematically review the literature for the best available evidence on safety and efficacy of radiofrequency ablation (RFA) and antiarrhythmic drug therapy (AAD) for treatment of atrial fibrillation (AF).
Methods: Two separate comprehensive literature reviews and Meta Analyses were performed on RFA and AAD therapy for treatment of AF. Of the 63 eligible studies in the RFA dataset, 9 were randomized controlled trials, an additional 18 were prospective comparative studies, 31 were prospective single-arm studies, and 12 were retrospective series. Of the 34 eligible AAD studies, 24 were RCTs.
Results: The single procedure success rate for RFA of AF overall was 72% (95% CI of 69–76%) in 53 treatment arms with 4855 patients. Single procedure success in patients not taking AADs was 57% (50 – 64%) in 32 arms with 2869 patients. Success after more than one ablation procedure was 77% (73– 81%) in 3562 patients in 42 arms. In patients not taking AAD the multiple procedure success was 71% (65–77%) in 34 arms with 3481 patients. Twenty-six percent (21–30%) of 4768 patients required repeat ablation therapy. In treatment arms where ablation was performed with an electroanatomic mapping system the procedure time was 159 min (95% CI of 135–183min) (35 arms with 3768 patients) while studies in which ablation did not utilize an electroanatomic mapping system reported a procedure time of 202 minutes (171–233min) (24 arms with 2514 patients). Similar results were found for fluoroscopy times. The overall success rate for all drug treatment groups was 46% (95% CI of 41–52%) in 40 treatment arms with 3835 patients. The incidence of complications associated with ablation was 5%. The incidence of complications associated with AAD therapy was 49%.
Conclusions: The results of our analysis reveal that studies of RFA for treatment of AF report higher overall efficacy rates than do studies of AAD therapy (72% versus 46%) and also a lower rate of complications (49% versus 5%).