Efficacy of ablation therapy on clinical outcomes in patients with atrial fibrillation: a systematic review and meta-analysis

Mohammad Munim Zahoor; Saad Ehsan Ullah; Harriet Mmaitsi Kidiavai; Shahda A.H Eltieb; Anjuli Devi; Muhammad Asif; A. Ramchandani Vaswani; Ammar Hyder; Muhammad Roshan Hoti; Sayed Jawad; Sana Arshid; Abhirami Shankar; Muhammad Salman

doi:10.1097/ms9.0000000000000985

June 28, 2023Annals of Medicine and SurgeryOpen Access

Efficacy of ablation therapy on clinical outcomes in patients with atrial fibrillation: a systematic review and meta-analysis

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Why the study?

The optimal treatment regimen for patients with AF remains unclear.

Does ablation therapy reduce stroke, mortality, and heart failure in patients with atrial fibrillation compared to pharmacological therapy?

Key Points

To compare clinical outcomes of ablation therapy versus pharmacological regimens in patients with atrial fibrillation.
Searched MEDLINE, Embase, and Cochrane Central databases for randomized controlled trials and observational studies comparing ablation to drug therapy.
Included approximately 200,000 patients across 4 randomized controlled trials and 7 observational studies.
Calculated pooled hazard ratios for stroke, mortality, heart failure, cardiovascular hospitalization, and bleeding using Mantel–Haenszel weighted random-effects models.
Ablation significantly reduced stroke (HR 0.51, 95% CI [0.43, 0.60], P < 0.00001), all-cause mortality (HR 0.64, 95% CI [0.45, 0.93], P = 0.02), cardiovascular mortality (HR 0.35, 95% CI [0.25, 0.50], P < 0.0001), and heart failure (HR 0.40, 95% CI [0.31, 0.53], P < 0.00001).
No significant differences occurred between groups for cardiovascular hospitalization (HR 1.04, 95% CI [0.88, 1.23], P = 0.66) or bleeding risk (HR 1.11, 95% CI [0.97, 1.27], P = 0.13).

Structured PICO

Does ablation therapy reduce stroke, mortality, and heart failure in patients with atrial fibrillation compared to pharmacological therapy?

P

Population

~200,000 patients with atrial fibrillation (pooled from 4 randomized controlled trials and 7 observational studies)

I

Intervention

Ablation therapy

C

Comparator

Pharmacological regimens (medical therapy alone)

O

Outcome

Stroke, all-cause mortality, cardiovascular mortality, cardiovascular hospitalization, heart failure (HF), and bleedinghard clinical

Ablation therapy in patients with atrial fibrillation is associated with significant reductions in stroke, mortality, and heart failure compared to medical therapy alone.

Implication

Ablation may be preferred over medical therapy alone for AF to reduce stroke and mortality; extends mixed RCT-observational evidence for clinical adoption.

Abstract

Background: Optimal treatment regimen for patients with atrial fibrillation (AF) remains unclear. Therefore, the authors sought to compare the outcomes of ablation therapy versus pharmacological regimens in patients with AF. Methods: MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials and observational studies comparing clinical outcomes between of ablation and pharmacological therapy in patients with AF. Stroke, all-cause mortality, cardiovascular mortality, cardiovascular hospitalization, heart failure (HF), and bleeding were among outcomes of interest. Mantel–Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95 % CIs. Results: The analysis included ~200 000 patients from 4 randomized controlled trials and 7 observational studies. Meta-analysis showed statistically significant reduction in stroke among patients on ablation therapy [hazard ratio (HR) 0.51, 95% CI (0.43, 0.60), P <0.00001, I2 =10%], all-cause mortality [HR 0.64, 95% CI (0.45, 0.93), P =0.02, I2 =58%], cardiovascular mortality [HR 0.35, 95% CI (0.25, 0.50), P <0.0001, I2 =0%], and HF [HR 0.40, 95% CI (0.31, 0.53), P <0.00001, I2 =30%]. However, no significant difference was revealed in the risk of cardiovascular hospitalization [HR 1.04, 95% CI (0.88, 1.23), P =0.66, I2 =89%] and bleeding [HR 1.11, 95% CI (0.97, 1.27), P =0.13, I2 =0%]. Conclusion: Ablation significantly reduces the risk of stroke, cardiovascular mortality, all-cause mortality, and HF in AF patients, compared with medical therapy alone, supporting its use in clinical practice.