Key result
Catheter ablation significantly reduced all-cause mortality compared to medical management in patients with atrial fibrillation (RR 0.72).
Why the study?
Observational studies showed a survival benefit with catheter ablation over medical management for AF, but RCT data remained uncertain.
Does catheter ablation reduce all-cause mortality compared to medical management in patients with atrial fibrillation?
Meta-Analysis (n=5,788)
Does catheter ablation reduce all-cause mortality compared to medical management in patients with atrial fibrillation?
Catheter ablation significantly reduces all-cause mortality and atrial arrhythmia recurrence compared to medical management in patients with atrial fibrillation, particularly those with concomitant heart failure, though it is associated with higher peri-procedural complications.
Answers are grounded in this paper and cite their sources.
Supports catheter ablation over medical therapy to reduce mortality in AF; confirms meta-analytic evidence and extends benefit particularly in HF.
Several observational studies have shown a survival benefit for patients with atrial fibrillation (AF) who are treated with catheter ablation (CA) rather than medical management (MM). However, data from randomized controlled trials (RCTs) are uncertain. Therefore, we performed a meta-analysis of RCTs that compared the benefits of CA and MM in treatment of AF. We searched the Cochrane Library, PubMed, and EMBASE databases for RCTs that compared AF ablation with MM from the time of database establishment up to January 2020. The risk ratio (RR) with a 95% confidence interval (CI) was used as a measure treatment effect. Twenty-six RCTs that enrolled a total of 5788 patients were included in the meta-analysis. In this meta-analysis, the effect of AF ablation depended on the baseline level of left ventricular ejection fraction (LVEF) in the heart failure (HF) patients. AF ablation appears to be of benefit to patients with a lesser degree of advanced HF and better LVEF by reducing mortality. Meanwhile, this mortality advantage was manifested in long-term follow-up. CA increased the risk for hospitalization when it was used as first-line therapy and decreased the risk when used as second-line therapy. CA reduced recurrence of atrial arrhythmia for different types of AF (paroxysmal or persistent AF) and CA-related complications were non-negligible. There was no convincing evidence for a reduction in long-term stroke risk after AF ablation, and additional high quality RCTs are needed to address that issue.
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Mao et al. (2020) conducted a meta-analysis in Atrial fibrillation (n=5,788). Catheter ablation vs. Medical management was evaluated on All-cause mortality (RR 0.72, 95% CI 0.57 to 0.90, p=0.005). Catheter ablation significantly reduced all-cause mortality compared to medical management in patients with atrial fibrillation (RR 0.72).
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