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Catheter ablation versus medical therapy for patients with persistent atrial fibrillation: a systematic review and meta-analysis of evidence from randomized controlled trials

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Abstract

Purpose

The superiority of catheter ablation (CA) for persistent (and long-standing persistent) atrial fibrillation (AF) is currently not well defined. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the clinical outcomes of CA compared with medical therapy in persistent AF patients.

Methods

We systematically searched PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov for RCTs comparing CA with medical therapy in patients with persistent AF. For CA vs medical rhythm control, the primary outcome was freedom from atrial arrhythmia. For CA vs medical rate control, the primary outcome was the change in the left ventricular ejection fraction (LVEF).

Results

Eight studies with a total of 809 patients were included in the final analysis. Compared with medical rhythm control, CA was superior in achieving freedom from atrial arrhythmia (RR 2.08, 95% CI [1.67, 2.58]; P < 0.00001). Similar result was found in CA arm without antiarrhythmic drug use after operation (RR 1.82, 95%CI [1.33, 2.49]; P = 0.0002). CA was also superior in reducing the probability of cardioversion (RR 0.59, 95%CI [0.46, 0.76]; P < 0.0001) and hospitalization (RR 0.54, 95%CI [0.39, 0.74]; P = 0.0002). Compared with the medical rate control in persistent AF patients with heart failure (HF), CA significantly improved the LVEF (MD 7.72, 95%CI [4.78, 10.67]; P < 0.00001) and reduced Minnesota Living with Heart Failure Questionnaire scores (MD 11.1395% CI [2.52–19.75]; P = 0.01).

Conclusions

CA appeared to be superior to medical therapy in persistent AF patients and might be considered as a first-line therapy for some persistent AF patients especially for those with HF.

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Funding

This study was funded by the National Natural Science Foundation of China (81673706), Zhejiang Province Key Social Development Projects of Major Scientific and Technological Special Projects (2015C0304), and Zhejiang Provincial Natural Science Foundation (LQ17H290003).

Author information

Author notes

  1. Chen Chen, Xinbin Zhou, and Min Zhu contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China

    Chen Chen, Xinbin Zhou, Min Zhu, Shenjie Chen, Jie Chen, Hongwen Cai, Jin Dai, Xiaoming Xu & Wei Mao

  2. The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China

    Chen Chen

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  1. Chen Chen
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Correspondence to Wei Mao.

Ethics declarations

No ethical approval and patient consent are required. Systematic review registration number is CRD42017081011.

Conflicts of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Supplement Fig. 1

Quality assessments of the RCTs with the Cochrane Collaboration tool (GIF 34 kb)

High Resolution Image (EPS 380 kb)

Supplement Fig. 2

Forest plot comparing catheter ablation and medical rhythm control in terms of freedom from atrial arrhythmia (GIF 12 kb)

High Resolution Image (EPS 376 kb)

Supplement Fig. 3

Funnel plot of comparison: catheter ablation vs medical rhythm control (GIF 6 kb)

High Resolution Image (EPS 57 kb)

Supplement Fig. 4

Forest plot comparing catheter ablation and medical rhythm control in terms of complications (GIF 11 kb)

High Resolution Image (EPS 345 kb)

Supplement Fig. 5

Forest plot comparing catheter ablation and medical rhythm control in terms of all-cause mortality(The standard continuity correction of 0.5) (GIF 11 kb)

High Resolution Image (EPS 16 kb)

Supplement Fig. 6

Funnel plot of comparison: catheter ablation vs medical rate control (GIF 6 kb)

High Resolution Image (EPS 52 kb)

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Chen, C., Zhou, X., Zhu, M. et al. Catheter ablation versus medical therapy for patients with persistent atrial fibrillation: a systematic review and meta-analysis of evidence from randomized controlled trials. J Interv Card Electrophysiol 52, 9–18 (2018). https://doi.org/10.1007/s10840-018-0349-8

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  • DOI: https://doi.org/10.1007/s10840-018-0349-8

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