Key result
Catheter ablation linked to ~85% higher atrial arrhythmia recurrence vs surgical ablation but fewer major events.
Why the study?
Randomized data directly comparing surgical versus catheter radiofrequency pulmonary vein ablation in patients with AF are limited.
Does video-assisted thoracoscopic surgical ablation reduce atrial arrhythmia recurrence compared to catheter ablation in patients with atrial fibrillation?
Meta-Analysis (n=511)
Does video-assisted thoracoscopic surgical ablation reduce atrial arrhythmia recurrence compared to catheter ablation in patients with atrial fibrillation?
Effect estimate: RR 1.85 (95% CI 1.44-2.39)
p-value: p=<0.001
Surgical ablation reduces atrial arrhythmia recurrence compared to catheter ablation in patients with atrial fibrillation, particularly in refractory paroxysmal AF, but at the cost of higher major adverse events.
Surgical ablation may reduce recurrence in refractory paroxysmal AF despite higher adverse events; extends Level 1 evidence for thoracoscopic approaches.
Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia with a high stroke and mortality rate. The video‐assisted thoracoscopic radiofrequency pulmonary vein ablation is a treatment option for patients who fail catheter ablation. Randomized data comparing surgical versus catheter ablation are limited. We performed a meta‐analysis of randomized control trials to explore the outcome efficacy between surgical and catheter radiofrequency pulmonary vein ablation in patients with AF. Methods We comprehensively searched the databases of MEDLINE and EMBASE from inception to December 2020. Included studies were published randomized control trials that compared video‐assisted thoracoscopic and catheter radiofrequency pulmonary vein ablation. Data from each study were combined using the fixed‐effects, generic inverse variance method of DerSimonian, and Laird to calculate odds ratios and 95% confidence intervals. Results Six studies from November 2013 to 2020 were included in this meta‐analysis involving 511 AF patients (79% paroxysmal) with 263 catheter ablation (mean age 56 ± 3 years) and 248 surgical ablations (mean age 52 ± 4 years). Catheter ablation was associated with increased atrial arrhythmias recurrence when compared to surgical ablation (pooled relative risk = 1.85, 95% confidence interval: 1.44−2.39, p < .001, I 2 = 0.0%) but associated with less total major adverse events (pooled relative risk = 0.29, 95% confidence interval: 0.16−0.53, p < .001, I 2 = 0.0%). In subgroup analysis, catheter ablation was associated with increased AF recurrence in refractory paroxysmal AF when compared to surgical ablation (pooled relative risk = 2.47, 95% confidence interval: 1.31−4.65, p = .005, I 2 = 0.0%) but not in persistent AF (relative risk = 1.09, 95% confidence interval: 0.60−2.0, p = .773). Conclusion Catheter ablation was associated with higher atrial arrhythmia recurrence when compared with surgical ablation. However, our study suggests that the benefit of surgical ablation in patients with persistent AF is unclear. More studies and alternative ablation strategies investigation in persistent AF are warranted.
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Rattanawong et al. (2022) conducted a meta-analysis in Atrial fibrillation (n=511). Catheter radiofrequency pulmonary vein ablation vs. Video-assisted thoracoscopic surgical ablation was evaluated on Atrial arrhythmias recurrence (RR 1.85, 95% CI 1.44-2.39, p=<0.001). Catheter ablation was associated with increased atrial arrhythmia recurrence compared to surgical ablation (RR 1.85; 95% CI 1.44-2.39; p<0.001), but had fewer major adverse events.
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