Key result
Radiofrequency ablation reduced the recurrence of atrial fibrillation compared to antiarrhythmic drugs at 24 months (OR 0.45; 95% CI 0.32-0.62), though this benefit decreased with longer follow-up.
Why the study?
Previous meta-analyses comparing radiofrequency ablation and antiarrhythmic drugs for atrial fibrillation did not consider the influence of follow-up time.
Does radiofrequency ablation reduce the recurrence of atrial fibrillation compared to antiarrhythmic drug therapy in patients with atrial fibrillation?
Meta-Analysis (n=1,542)
Does radiofrequency ablation reduce the recurrence of atrial fibrillation compared to antiarrhythmic drug therapy in patients with atrial fibrillation?
Radiofrequency ablation is more effective than antiarrhythmic drugs for preventing atrial fibrillation recurrence, with benefits persisting long-term but decreasing over time, though it carries a higher risk of serious complications.
Answers are grounded in this paper and cite their sources.
Favors radiofrequency ablation over antiarrhythmic drugs to reduce AF recurrence at 24 months; extends meta-analytic support while noting waning long-term benefit.
BACKGROUND: Radiofrequency ablation (RFA) and antiarrhythmic drugs (AADs) are the main treatments used for atrial fibrillation (AF). In recent years, a number of articles comparing the 2 treatments have begun to emerge. Though, the influence of follow-up time in the meta-analysis was not considered in these articles. However, more recently, large-scale clinical trial articles have included follow-up with the patients up to 5 years after treatment. Therefore, the aim of this study was to assess the impact of variable follow-up times on the recurrence of AF by observing both the short-term and long-term efficacy and safety of catheter ablation and AADs for the treatment of AF. METHODS AND RESULTS: The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random effect summary estimates were calculated as standardized mean differences and odds ratios with 95% confidence intervals for continuous and binary outcomes. In this study, 9 randomized controlled trials (n = 1542 patients) were included. The rate of recurrence of AF with no limit on follow-up time, >12 months, >18 months, >24 months, >30 months, and approximately 36 months was compared. Furthermore, the gap between the RFA and AAD groups in the recurrence rate of AF was found to decrease inversely to follow-up time. When the follow-up time reached 24 months, the difference between RFA and AAD was relatively stable with an odds ratio of 0.45 (95% confidence interval: 0.32-0.62). Overall, RFA decreased adverse events in the remaining trials; however, AAD performed better in terms of safety and had fewer adverse events with RFA usually causing more serious complications. CONCLUSION: RFA is more advantageous in terms of recurrence rate of AF than drug therapy. In addition, the analysis suggests that this effect persists during long-term follow-up; however, these benefits appear to decrease with longer follow-up time. Finally, AAD performed better in terms of safety and had fewer adverse events.
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Fang et al. (2019) conducted a meta-analysis in Atrial Fibrillation (n=1,542). Radiofrequency ablation (RFA) vs. Antiarrhythmic drugs (AADs) was evaluated on Recurrence of atrial fibrillation (OR 0.45, 95% CI 0.32-0.62). Radiofrequency ablation reduced the recurrence of atrial fibrillation compared to antiarrhythmic drugs at 24 months (OR 0.45; 95% CI 0.32-0.62), though this benefit decreased with longer follow-up.
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