What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial fibrillation (n=104687). Intervention: Catheter ablation vs. Nonablation. Primary outcome: Total thromboembolic events (RR 0.65, 95% CI 0.51-0.82, p=0.0003).

March 11, 2020Open Access

Opposite effect of ablation on early/late‐phase thromboembolic incidence in patients with atrial fibrillation: A meta‐analysis on more than 100 000 individuals

Key Result

Catheter ablation in patients with atrial fibrillation was associated with a 35% lower risk of total thromboembolic events compared to nonablation (RR 0.65; 95% CI 0.51-0.82; P=0.0003).

Study Design

Type

Meta-Analysis (n=104,687)

Structured PICO

Does catheter ablation reduce thromboembolic events in patients with atrial fibrillation compared to nonablation?

Population

104,687 patients with atrial fibrillation from 25 studies (12 RCTs and 13 observational studies)

Intervention

Catheter ablation

Comparator

Nonablation

Outcome

Total thromboembolic eventshard clinical

Catheter ablation for atrial fibrillation is associated with a lower overall and late-phase risk of thromboembolism, but a doubled risk during the early (<30 days) postoperative period.

Main Result

Effect estimate: RR 0.65 (95% CI 0.51-0.82)

p-value: p=0.0003

Limitations

Sample size of included RCTs was too small to be conclusive in subgroup analysis

Abstract

BACKGROUND: Atrial fibrillation (AF) is an important risk factor for thromboembolic events, for which catheter ablation represents an effective therapy for rhythm control. Intuitively, ablation may reduce the incidence of thromboembolism, but data is quite limited. HYPOTHESIS: Catheter ablation was associated with the fewer risk of thromboembolism compared with nonablation in patients with AF. METHODS: A systematic search was performed in PubMed, EMBASE, the Web of Science, and the Cochrane Library from inception to September 2019. Random-effects model was used to estimate the risk ratios (RR) for the thromboembolic events between the ablation and nonablation groups. RESULTS: Twenty-five studies (12 randomized controlled trials and 13 observational studies) with 104 687 participants were included. Pooled analysis suggested that ablation was associated with a 35% lower risk of total thromboembolic events compared to nonablation group (RR = 0.65; 95% CI, 0.51-0.82; P = .0003). When separated into early-phase (30 days) events, ablation was associated with an increased early-phase thromboembolism (RR = 1.96; 95% CI, 1.35-2.83; P = .0004) but a decreased late-phase thromboembolism (RR = 0.75; 95% CI, 0.63-0.90; P = .002). Subgroup analysis according to different study types found similar results were found in observation studies, but not in RCT studies because the sample size was too small to be conclusive. CONCLUSIONS: In patients with AF, catheter ablation was associated with a fewer risk of overall and late-phase thromboembolism in comparison with nonablation. However, over the early postoperative period, catheter ablation was associated with the double higher risk of thromboembolic events.