Key result
RFCA cuts AF recurrence ~83% vs AADs at 1 year.
Why the study?
Does radiofrequency catheter ablation reduce the recurrence of atrial fibrillation compared to antiarrhythmic drugs in patients with symptomatic atrial fibrillation?
Meta-Analysis (n=1,861)
Does radiofrequency catheter ablation reduce the recurrence of atrial fibrillation compared to antiarrhythmic drugs in patients with symptomatic atrial fibrillation?
Relative Risk: 0.17 (95% CI 0.1–0.31)
Absolute Event Rate: 28% vs 61%
p-value: p=<0.001
Radiofrequency catheter ablation is significantly more effective than antiarrhythmic drugs at preventing atrial fibrillation recurrence at 1 year, supporting its use in symptomatic patients.
Supports ablation over drugs for symptomatic AF; strengthens Level 1 evidence from aggregated RCTs.
Background: The evidence regarding the efficacy and safety of radiofrequency catheter ablation (RFCA) in symptomatic atrial fibrillation (AF) is growing. Recently new randomized controlled trials (RCTs) comparing both treatment modalities have been published. Some of them have reported long-term outcome of patients. Objectives: Therefore, we conducted a systematic review and meta-analysis of the available data to further evaluate the efficacy and safety of RFCA vs. antiarrhythmic drugs (AADs). Methods: PubMed and Cochrane Library were searched from January 1st, 2002 to Oct 31st, 2016. Recurrence of any atrial fibrillation and rate of adverse events were the end-points of the analysis. Two authors reviewed the trials, and odds ratios were calculated using a random effects model using RevMan5. Results: A total of 12 studies, including 1861 patients, were identified. Two studies reported of long-term outcome. In the study group with 1 year follow-up, 210 of 749 patients (28%) in the RFCA group had an AF recurrence vs 407 of 669 patients (61%) in the AAD group. The risk of any atrial arrhythmia (risk ratio, RR 95% confidence interval [95% CI] = 0.17 [0.10–0.31], p<0.001) was significantly higher in AAD group (Figure1). However, inter-study heterogeneity was significant (I-squared = 80%, p<0.001).
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Parwani et al. (2017) conducted a meta-analysis in symptomatic atrial fibrillation (AF) (n=1,861). radiofrequency catheter ablation (RFCA) vs. antiarrhythmic drugs (AADs) was evaluated on Recurrence of any atrial fibrillation (RR 0.17, 95% CI 0.10-0.31, p=<0.001). Radiofrequency catheter ablation significantly reduced the risk of atrial fibrillation recurrence compared to antiarrhythmic drugs at 1 year (28% vs 61%; RR 0.17; 95% CI 0.10-0.31; p<0.001).
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