What question did this study set out to answer?

To assess the safety of catheter ablation compared to antiarrhythmic drugs for managing atrial fibrillation.

March 22, 2026Open Access

Safety of Catheter Ablation compared with Antiarrhythmic Drugs for Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomised Trials

Key Result

Catheter ablation reduced serious adverse events by 20% (RR 0.80) and unplanned hospitalizations by 47% compared with antiarrhythmic drugs in patients with atrial fibrillation.

Key Points

To assess the safety of catheter ablation compared to antiarrhythmic drugs for managing atrial fibrillation.
Conducted a systematic review and meta-analysis of randomised controlled trials (RCTs)
Searched MEDLINE, Embase, and Cochrane CENTRAL up to October 2024
Primary endpoint was a composite of serious adverse events including death and hospitalisation
Included 24 RCTs with a total of 6,665 participants, comparing outcomes of catheter ablation and antiarrhythmic drugs
Catheter ablation reduced the risk of serious adverse events by 20% (RR 0.80, 95% CI 0.69-0.93)
A 47% reduction in risk of unplanned hospitalisation was associated with catheter ablation (RR 0.53, 95% CI 0.38-0.72)
Catheter ablation led to a 37% lower risk of adverse cardiovascular events (RR 0.63, 95% CI 0.44-0.90)

Structured PICO

Does catheter ablation reduce serious adverse events compared with antiarrhythmic drugs in patients with atrial fibrillation?

Population

6,665 adults (>18 years) with atrial fibrillation (paroxysmal, persistent, or permanent) pooled from 24 RCTs. Mean age ranged from 51 to 71.5 years, 12% to 58% female.

Intervention

Catheter ablation (cryoablation in 5 studies, radiofrequency ablation in 19 studies) as first-line or subsequent therapy

Comparator

Antiarrhythmic drugs (amiodarone only in 3 studies, various class I/III AADs in 21 studies)

Outcome

Composite of serious adverse events (SAE), including death, life-threatening condition, permanent impairment, significant health deterioration, or requiring medical or surgical intervention, unplanned hospitalisation, or extension of index hospitalisation by more than 24 hourssafety

Catheter ablation for atrial fibrillation demonstrates a superior safety profile compared to antiarrhythmic drugs, significantly reducing the risk of serious adverse events and unplanned hospitalizations.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: Catheter ablation (CA) is superior to antiarrhythmic drugs (AADs) for maintaining sinus rhythm in atrial fibrillation (AF).However, most randomised controlled trials (RCTs) lack the power to assess CA safety.Objective: To evaluate complication rates and relative risks of CA compared with AADs for AF rhythm management.Methods: MEDLINE, Embase and Cochrane CENTRAL (inception-Oct 24, 2024) were searched for RCTs comparing CA vs. AADs in AF management.The primary endpoint was a composite of serious adverse events (SAE), including death, additional intervention, prolonged or unplanned hospitalisation or disability.Secondary endpoints included SAE components.A random-effects meta-analysis estimated pooled risk ratios (RR) with 95% confidence intervals (CI).Results: Twenty-four randomised trials comprising 6,665 participants were included in the meta-analysis, with 3,554 patients (53.2%) assigned to the catheter ablation group and 3,111 patients (46.7%) to the antiarrhythmic drug group.During a 12-month median follow-up (6-60 months), CA was associated with a 20% lower risk of SAE compared with AAD (RR 0.80, 95% CI 0.69-0.93,I 2 0%, p < 0.01) and 47% reduction in risk unplanned hospitalisation (RR 0.53, 95% CI 0.38-0.72,I 2 73%, p < 0.01).CA was also associated with a 37% lower risk of adverse cardiovascular events (RR 0.63, 95% CI 0.44-0.90,I2 42%, p = 0.01).Conclusions: CA for AF rhythm management reduced SAEs, unplanned hospitalisation and adverse cardiovascular events compared with AADs.When patient safety is being considered, AAD appears to have a less favourable safety profile than catheter ablation in AF.

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