Abstract 15897: Superior Efficacy of Catheter Ablation for Atrial Fibrillation Over Antiarrhythmic Drug Therapy for Maintaining Sinus Rhythm: Meta-Analysis of 12 Randomized Controlled Trials with 1694 Patients
Introduction: There is debate regarding the ideal rhythm-control strategy for maintaining sinus rhythm in patients with atrial fibrillation (AF). We report a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing catheter ablation with antiarrhythmic drug therapy (ADT) to maintain sinus rhythm in patients with AF.
Methods: We searched Pubmed, Embase, and Cochrane Central Register of Controlled Trials for RCTs comparing catheter ablation vs. ADT for AF. Random-effects models were used to estimate the primary outcome of atrial tachyarrhythmia (AT) recurrence and secondary outcomes of major adverse events and death during follow-up.
Results: A total of 12 RCTs (1694 patients) were included. Catheter ablation was associated with lower risk of AT recurrence as compared to ADT (26.5% vs. 69.1%, pooled risk ratio 0.36, 95% CI 0.28-0.47, p<0.0001; Figure 1). Among the secondary endpoints, risk of major adverse events was lower with catheter ablation (8.1% vs. 13.3%, RR 0.63, 95% CI 0.42-0.95, p=0.03) as compared to ADT and there was no difference in mortality between the two groups (0.92% vs. 1.27%, RR 0.83, 95% CI 0.31-2.21, p=0.83).
Conclusions: Catheter ablation is safer and more efficacious than ADT to maintain sinus rhythm and therefore should be the preferred treatment strategy for rhythm-control in selected patients with symptomatic AF. Figure 1: Meta-analysis of catheter ablation vs. antiarrhythmic drug therapy (ADT) for atrial fibrillation - relative risk of atrial tachyarrhythmia recurrence during follow-up.
- © 2012 by American Heart Association, Inc.