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Catheter ablation versus anti-arrhythmic drug therapy for the management of a trial fibrillation: a meta-analysis

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Abstract

Purposes

The current study was a meta-analysis designed to compare the therapeutic efficacy and safety of catheter ablation with those of anti-arrhythmic drugs, over the short and long term.

Methods

Comparative studies (randomized controlled trials) of catheter ablation vs. anti-arrhythmic drugs for the treatment of AF were retrieved from MEDLINE and EM BASE. The primary (no recurrence of AF) and secondary (major adverse events) outcomes were compared by meta-analysis, with sub-group analysis of short-term (1 year or less) and long-term (>1 year) effects.

Results

Of the 223 studies originally identified, 214 were excluded (duplication, non-randomized design, lack of relevance or lack of usable data). Compared with anti-arrhythmic drug therapy, catheter ablation was associated with superior efficacy (odds ratio [OR], 9.41; 95 % confidence interval [95 % CI], 5.00–17.71; P < 0.01). Treatment success was higher for catheter ablation both in the short term (OR, 10.84; 95 % CI, 5.83–20.16; P < 0.001) and long term (OR, 7.65; 95 % CI, 1.97–29.73; P = 0.03). There was a trend toward a lower incidence of adverse events in the catheter ablation group (OR, 2.19; 95 % CI, 0.99–4.85), but this did not reach statistical significance (P = 0.05).

Conclusion

Compared with anti-arrhythmic drugs, management of AF with catheter ablation showed superior efficacy in the short term that was maintained over the longer term.

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References

  1. Chugh, S. S., Havmoeller, R., Narayanan, K., Singh, D., Rienstra, M., Benjamin, E. J., et al. (2013). Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation, 129(8), 837–847.

  2. Colilla, S., Crow, A., Petkun, W., Singer, D. E., Simon, T., & Liu, X. (2013). Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. The American Journal of Cardiology, 112(8), 1142–1147.

    Article  PubMed  Google Scholar 

  3. Friberg, L., & Bergfeldt, L. (2013). Atrial fibrillation prevalence revisited. Journal of Internal Medicine, 274(5), 461–468.

    Article  CAS  PubMed  Google Scholar 

  4. Li, Y., Wu, Y. F., Chen, K. P., Li, X., Zhang, X., Xie, G. Q., et al. (2013). Prevalence of atrial fibrillation in china and its risk factors. Biomedical and Environmental Sciences, 26(9), 709–716.

    PubMed  Google Scholar 

  5. Norberg, J., Backstrom, S., Jansson, J. H., & Johansson, L. (2013). Estimating the prevalence of atrial fibrillation in a general population using validated electronic health data. Clin Epidemiol, 5, 475–481.

    PubMed Central  PubMed  Google Scholar 

  6. Wilke, T., Groth, A., Mueller, S., Pfannkuche, M., Verheyen, F., Linder, R., et al. (2013). Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace, 15(4), 486–493.

    Article  PubMed  Google Scholar 

  7. Lloyd-Jones, D. M., Wang, T. J., Leip, E. P., Larson, M. G., Levy, D., Vasan, R. S., et al. (2004). Lifetime risk for development of atrial fibrillation: the Framingham heart study. Circulation, 110(9), 1042–1046.

    Article  PubMed  Google Scholar 

  8. Anderson, J. L., Halperin, J. L., Albert, N. M., Bozkurt, B., Brindis, R. G., Curtis, L. H., et al. (2013). Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): a report of the American College Of Cardiology/American Heart Association Task Force On Practice Guidelines. Journal of the American College of Cardiology, 61(18), 1935–1944.

    Article  PubMed  Google Scholar 

  9. Investigators, A. F. A. D. S. (2003). Maintenance of sinus rhythm in patients with atrial fibrillation: an AFFIRM substudy of the first antiarrhythmic drug. Journal of the American College of Cardiology, 42(1), 20–29.

    Article  Google Scholar 

  10. Roy, D., Talajic, M., Dorian, P., Connolly, S., Eisenberg, M. J., Green, M., et al. (2000). Amiodarone to prevent recurrence of atrial fibrillation canadian trial of atrial fibrillation investigators. N ew England Journal of Medicine, 342(13), 913–920.

    Article  CAS  Google Scholar 

  11. Singh, B. N., Singh, S. N., Reda, D. J., Tang, X. C., Lopez, B., Harris, C. L., et al. (2005). Amiodarone versus sotalol for atrial fibrillation. The New England Journal of Medicine, 352(18), 1861–1872.

    Article  CAS  PubMed  Google Scholar 

  12. Cosedis Nielsen, J., Johannessen, A., Raatikainen, P., Hindricks, G., Walfridsson, H., Kongstad, O., et al. (2012). Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. The New England Journal of Medicine, 367(17), 1587–1595.

    Article  PubMed  Google Scholar 

  13. Forleo, G. B., Mantica, M., De Luca, L., Leo, R., Santini, L., Panigada, S., et al. (2009). Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy. Journal of Cardiovascular Electrophysiology, 20(1), 22–28.

    Article  PubMed  Google Scholar 

  14. Jais, P., Cauchemez, B., Macle, L., Daoud, E., Khairy, P., Subbiah, R., et al. (2008). Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation, 118(24), 2498–2505.

    Article  PubMed  Google Scholar 

  15. Packer, D. L., Kowal, R. C., Wheelan, K. R., Irwin, J. M., Champagne, J., Guerra, P. G., et al. (2013). Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. Journal of the American College of Cardiology, 61(16), 1713–1723.

    Article  PubMed  Google Scholar 

  16. Pappone, C., Vicedomini, G., Augello, G., Manguso, F., Saviano, M., Baldi, M., et al. (2011). Radiofrequency catheter ablation and antiarrhythmic drug therapy: a prospective, randomized, 4-year follow-up trial: the APAF study. Circulation. Arrhythmia and Electrophysiology, 4(6), 808–814.

    Article  PubMed  Google Scholar 

  17. Pokushalov, E., Romanov, A., De Melis, M., Artyomenko, S., Baranova, V., Losik, D., et al. (2013). Progression of atrial fibrillation after a failed initial ablation procedure in patients with paroxysmal atrial fibrillation: a randomized comparison of drug therapy versus reablation. Circulation. Arrhythmia and Electrophysiology, 6(4), 754–760.

    Article  CAS  PubMed  Google Scholar 

  18. Stabile, G., Bertaglia, E., Senatore, G., De Simone, A., Zoppo, F., Donnici, G., et al. (2006). Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (catheter ablation for the cure of atrial fibrillation study). European Heart Journal, 27(2), 216–221.

    Article  PubMed  Google Scholar 

  19. Wazni, O. M., Marrouche, N. F., Martin, D. O., Verma, A., Bhargava, M., Saliba, W., et al. (2005). Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA, 293(21), 2634–2640.

    Article  CAS  PubMed  Google Scholar 

  20. Wilber, D. J., Pappone, C., Neuzil, P., De Paola, A., Marchlinski, F., Natale, A., et al. (2010). Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA, 303(4), 333–340.

    Article  CAS  PubMed  Google Scholar 

  21. Ganesan, A. N., Shipp, N. J., Brooks, A. G., Kuklik, P., Lau, D. H., Lim, H. S., et al. (2013). Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Am Heart Assoc, 2(2), e004549.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Chen, H. S., Wen, J. M., Wu, S. N., & Liu, J. P. (2012). Catheter ablation for paroxysmal and persistent atrial fibrillation. Cochrane Database of Systematic Reviews, 4, CD007101.

    PubMed  Google Scholar 

  23. Piccini, J. P., Lopes, R. D., Kong, M. H., Hasselblad, V., Jackson, K., & Al-Khatib, S. M. (2009). Pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation: a meta-analysis of randomized, controlled trials. Circulation. Arrhythmia and Electrophysiology, 2(6), 626–633.

    Article  PubMed  Google Scholar 

  24. Gjesdal, K., Vist, G. E., Bugge, E., Rossvoll, O., Johansen, M., Norderhaug, I., et al. (2008). Curative ablation for atrial fibrillation: a systematic review. Scandinavian Cardiovascular Journal, 42(1), 3–8.

    Article  PubMed  Google Scholar 

  25. Noheria, A., Kumar, A., Wylie, J. V., Jr., & Josephson, M. E. (2008). Catheter ablation vs antiarrhythmic drug therapy for atrial fibrillation: a systematic review. Archives of Internal Medicine, 168(6), 581–586.

    Article  PubMed  Google Scholar 

  26. Calkins, H., Reynolds, M. R., Spector, P., Sondhi, M., Xu, Y., Martin, A., et al. (2009). Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circulation. Arrhythmia and Electrophysiology, 2(4), 349–361.

    Article  CAS  PubMed  Google Scholar 

  27. Bonanno, C., Paccanaro, M., La Vecchia, L., Ometto, R., & Fontanelli, A. (2010). Efficacy and safety of catheter ablation versus antiarrhythmic drugs for atrial fibrillation: a meta-analysis of randomized trials. Journal of Cardiovascular Medicine (Hagerstown, Md.), 11(6), 408–418.

    Article  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Cardiovascular Department, Xin Qiao Hospital of the Third Military Medical University, Chongqing, 400037, China

    Xiaofeng Cheng, Xiaoqing Li, Yun He, Xiaoyan Liu, Guoqiang Wang, Li Cheng & Jianbo Hu

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  1. Xiaofeng Cheng
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  2. Xiaoqing Li
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  3. Yun He
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  4. Xiaoyan Liu
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  6. Li Cheng
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Correspondence to Xiaofeng Cheng or Xiaoqing Li.

Additional information

Xiaofeng Cheng and Xiaoqing Li contributed equally to this work.

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Cheng, X., Li, X., He, Y. et al. Catheter ablation versus anti-arrhythmic drug therapy for the management of a trial fibrillation: a meta-analysis. J Interv Card Electrophysiol 41, 267–272 (2014). https://doi.org/10.1007/s10840-014-9945-4

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  • DOI: https://doi.org/10.1007/s10840-014-9945-4

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