Key result
Catheter ablation for AF linked to ~20% lower risk of serious adverse events vs AADs.
Why the study?
Catheter ablation is superior to antiarrhythmic drugs for maintaining sinus rhythm in AF, but most randomised controlled trials lack statistical power to assess catheter ablation safety.
Does catheter ablation reduce serious adverse events compared to antiarrhythmic drugs in patients with atrial fibrillation?
Meta-Analysis (n=6,665)
Does catheter ablation reduce serious adverse events compared to antiarrhythmic drugs in patients with atrial fibrillation?
Effect estimate: RR 0.80 (95% CI 0.69-0.93)
p-value: p=<0.01
Catheter ablation for atrial fibrillation rhythm management is associated with a significantly lower risk of serious adverse events compared to antiarrhythmic drugs.
Supports preferring catheter ablation over drugs to reduce serious adverse events in atrial fibrillation; extends prior randomized evidence on rhythm-control safety.
Background and Aims 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. Hence, we sought to evaluate complication rates and relative risks of CA compared with AADs for the rhythm management of AF. Methods We searched MEDLINE, Embase, and Cochrane CENTRAL (inception–Oct 24, 2024) 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 24 randomised trials comprising 6,665 participants (53.2% in the CA group) met the inclusion criteria. On follow-up (ranging from 6 to 60 months), 673 (10.1%) patients in either group developed SAEs. CA was associated with a 20% lower risk of serious adverse events compared with AAD (RR 0.80, 95% CI 0.69-0.93, I2 0%, p<0.01) and 47% reduction in risk unplanned hospitalisation (RR 0.53, 95% CI 0.38-0.72, I2 73%, p<0.01). Additionally, compared to AAD, CA was associated with a 37% lower risk of adverse cardiovascular events related to therapy (RR 0.63, 95% CI 0.44-0.90, I2 42%, p=0.01). Conclusions Catheter ablation for AF rhythm management reduced serious adverse events, unplanned hospitalisation, and adverse cardiovascular events compared to AADs. Across the spectrum of AF, rhythm control with antiarrhythmic drugs should not be preferred to catheter ablation on the grounds of patient safety.
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Shawki et al. (2025) conducted a meta-analysis in Atrial fibrillation (n=6,665). Catheter ablation vs. Antiarrhythmic drugs (AADs) was evaluated on Composite of serious adverse events (SAE), including death, additional intervention, prolonged or unplanned hospitalisation, or disability (RR 0.80, 95% CI 0.69-0.93, p=<0.01). Catheter ablation for atrial fibrillation rhythm management was associated with a 20% lower risk of serious adverse events compared with antiarrhythmic drugs (RR 0.80; 95% CI 0.69-0.93; p<0.01).
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