Abstract 20570: Geographic Representation and Reported Success Rates of Studies of Catheter Ablation for Atrial Fibrillation: Findings From the SMASH-AF Meta-Analysis Study Cohort
Introduction: Systematic reviews of catheter ablation for atrial fibrillation (AF) have large unexplained study heterogeneity. Geographic differences in study population or procedure strategy may be explanatory. We therefore performed a meta-analysis to describe, and identify drivers of, geographic heterogeneity of AF ablation success rates.
Methods: We searched PubMed, Scopus and Cochrane Databases from 1/1/1990 to 5/1/2016 for trials and observational studies reporting AF ablation success rates. The full protocol is registered with PROSPERO. Single procedure freedom from tachyarrhythmia off antiarrhythmic agents was the primary outcome and other definitions of success were secondary outcomes. Major exclusion criteria were insufficient reporting of outcomes, sample size < 40 patients, and ablation strategies that were not prespecified and uniform. We grouped treatment arms by paroxysmal AF (PAF) and non-paroxysmal AF (NPAF) type. Study country was defined as country where all ablations were performed. Analyses used a random-effects model and multivariate meta-regressions controlled for duration of follow-up and recurrence screening modality. We excluded countries with ≤ 5 treatment arms.
Results: A total of 184 studies from 15 countries (PAF: 243 treatment arms, n=27,633; NPAF 123 treatment arms, n=11,390) met inclusion. Unadjusted success rates ranged from 65-82% for PAF and 53-71% for NPAF groups. Almost half of PAF and NPAF treatment arms came from four (Germany, Japan, China, USA) and two countries (USA and Germany), respectively. After controlling for covariates, the top quartile countries in the PAF group were Turkey (81%), South Korea (82%), and Belgium (83%) (I2 residual > 87%). After controlling for covariates, the top quartile countries in the NPAF group were USA (73%) and Japan (73%) (I2 residual > 93%). Multinational studies, controlling for covariates, had success rates of 70% for PAF and 51% for NPAF groups.
Conclusions: Success rates of AF ablation vary substantially by country. Multinational studies reported conservative success rates, potentially reflective of more rigorous study methods or regression to the mean due to larger size. Large residual heterogeneity requires further exploration.
Author Disclosures: G.C. Leef: None. A.C. Perino: None. F.N. Yunus: None. A. Cluckey: None. M. Turakhia: Research Grant; Modest; Medtronic, Inc., iRhythm Technologies. Research Grant; Significant; Janssen Pharmaceuticals, Inc. Consultant/Advisory Board; Modest; Medtronic, Inc., Daiichi, Sankyo Pharmaceuticals., St Jude Medical, Precision Health Economics.
- © 2016 by American Heart Association, Inc.