Skip to main content
SpringerLink
Log in

Outcomes of catheter ablation versus antiarrhythmic therapy in patients with atrial fibrillation: a systematic review and meta-analysis

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Recent data have shown an advantage of rhythm control over rate control for the treatment of atrial fibrillation (AF). Nevertheless, the data regarding efficacy of catheter ablation (CA) compared with antiarrhythmic drugs (AADs) in patients with AF is lacking. Therefore, we sought to evaluate recurrence of arrhythmia, all-cause mortality, cardiovascular deaths, stroke/TIA, and all-cause readmissions of CA compared with AAD in patients with AF.

Methods

Systematically searched through PubMed, Google Scholar, EMBASE, and Cochrane for randomized control trials that compared CA and AAD in atrial fibrillation patients. Review Manager 5.4 and OpenMetaAnalyst were used to analyze the data. Data was pooled for the outcomes using random-effect models (DerSimonian and Laird) and reported as pooled odds ratio (OR).

Results

A total of 4822 patients were included. The CA group had 2417 patients while the AAD group included 2405 patients. Pooled data demonstrated that the CA arm had a statistically significant decrease in risk for recurrence of arrhythmia as compared to AAD (OR 0.25; [95% CI, 0.18–0.36]; p < 0.001). All-cause readmission was statistically significantly lower in CA as compared to AAD (OR 0.33; [95%CI, 0.17–0.63]; p < 0.001). For other secondary outcomes, there was no statistically significant difference between CA and AAD with regard to all-cause mortality (OR 0.75; [95% CI, 0.55–1.03]), cardiovascular death (OR 0.76; [95% CI, 0.22–2.54]), bleeding (OR 1.09, [95% CI 0.74, 1.61]), or stroke/TIA outcome (OR 0.90, [95% CI, 0.59–1.37]).

Conclusions

In this study of pooled data from 16 RCTs, CA utilization for atrial fibrillation had improved freedom from arrhythmia as well as reduced all-cause readmission compared with AAD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 25
Fig. 26
Fig. 27
Fig. 28
Fig. 29
Fig. 30
Fig. 31

Similar content being viewed by others

References

  1. Lévy, Samuel et al. Management of atrial fibrillation: two decades of progress - a scientific statement from the European Cardiac Arrhythmia Society. J Interv Cardiac Electrophysiol : Int J Arrhythmias Pacing. 13 2022;https://doi.org/10.1007/s10840-022-01195-z

  2. Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, Fetsch T, van Gelder IC, Haase D, Haegeli LM, Hamann F, Heidbüchel H, Hindricks G, Kautzner J, Kuck KH, Mont L, Ng GA, Rekosz J, Schoen N, Schotten U, Suling A, Taggeselle J, Themistoclakis S, Vettorazzi E, Vardas P, Wegscheider K, Willems S, Crijns HJGM, Breithardt G, EAST-AFNET 4 Trial Investigators. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med. 2020;383(14):1305–16. https://doi.org/10.1056/NEJMoa2019422.

    Article  Google Scholar 

  3. Asad ZUA, Yousif A, Khan MS, Al-Khatib SM, Stavrakis S. Catheter ablation versus medical therapy for atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials. Circ Arrhythm Electrophysiol. 2019;12(9):e007414. https://doi.org/10.1161/CIRCEP.119.007414.

    Article  Google Scholar 

  4. Calkins, Hugh et al. HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace : European pacing, arrhythmias, and cardiac electrophysiology : J Working Groups Cardiac Pacing Arrhythmias Cardiac Cell Electrophysiol Eur Soc Cardiol. 2017;20 1 (2018): e1-e160. https://doi.org/10.1093/europace/eux274

  5. Packer DL, et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019;321(13):1261–74. https://doi.org/10.1001/jama.2019.0693.

    Article  CAS  Google Scholar 

  6. Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma G. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  Google Scholar 

  7. Hunter RJ, et al. A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial). Circ Arrhythm Electrophysiol. 2014;7(1):31–8. https://doi.org/10.1161/CIRCEP.113.000806.

    Article  CAS  Google Scholar 

  8. Prabhu S, et al. Catheter ablation versus medical rate control in atrial fibrillation and systolic dysfunction: the CAMERA-MRI study. J Am Coll Cardiol. 2017;70(16):1949–61. https://doi.org/10.1016/j.jacc.2017.08.041.

    Article  Google Scholar 

  9. MacDonald MR, et al. Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: a randomised controlled trial. Heart (British Cardiac Society). 2011;97(9):740–7. https://doi.org/10.1136/hrt.2010.207340.

    Article  Google Scholar 

  10. McGuinness, LA, Higgins, JPT. Risk-of-Bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Syn Meth. 2020; 1- 7. https://doi.org/10.1002/jrsm.1411

  11. Di Biase L, et al. Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device: results from the AATAC multicenter randomized trial. Circulation. 2016;133(17):1637–44. https://doi.org/10.1161/CIRCULATIONAHA.115.019406.

    Article  CAS  Google Scholar 

  12. Jaïs P, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation. 2008;118(24):2498–505. https://doi.org/10.1161/CIRCULATIONAHA.108.772582.

    Article  Google Scholar 

  13. Nielsen JC, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. New Engl J Med. 2012;367(17):1587–95. https://doi.org/10.1056/NEJMoa1113566.

    Article  CAS  Google Scholar 

  14. Oral H, et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. New Engl J Med. 2006;354(9):934–41. https://doi.org/10.1056/NEJMoa050955.

    Article  CAS  Google Scholar 

  15. Stabile G, et al. 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). Eur Heart J. 2006;27(2):216–21. https://doi.org/10.1093/eurheartj/ehi583.

    Article  Google Scholar 

  16. Pappone C, et al. Radiofrequency catheter ablation and antiarrhythmic drug therapy: a prospective, randomized, 4-year follow-up trial: the APAF study. Circ Arrhythm Electrophysiol. 2011;4(6):808–14. https://doi.org/10.1161/CIRCEP.111.966408.

    Article  Google Scholar 

  17. Forleo GB, et al. 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. J Cardiovasc Electrophysiol. 2009;20(1):22–8. https://doi.org/10.1111/j.1540-8167.2008.01275.x.

    Article  Google Scholar 

  18. Krittayaphong R, et al. A randomized clinical trial of the efficacy of radiofrequency catheter ablation and amiodarone in the treatment of symptomatic atrial fibrillation. J Med Assoc Thail= Chotmaihet Thangphaet. 2003;86(Suppl 1):S8-16.

    Google Scholar 

  19. Morillo CA, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA. 2014;311(7):692–700. https://doi.org/10.1001/jama.2014.467.

    Article  CAS  Google Scholar 

  20. Andrade JG, et al. Cryoablation or drug therapy for initial treatment of atrial fibrillation. New Engl J Med. 2021;384(4):305–15. https://doi.org/10.1056/NEJMoa2029980.

    Article  CAS  Google Scholar 

  21. Mont L, et al. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J. 2014;35(8):501–7. https://doi.org/10.1093/eurheartj/eht457.

    Article  Google Scholar 

  22. Wazni OM, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA. 2005;293(21):2634–40. https://doi.org/10.1001/jama.293.21.2634.

    Article  CAS  Google Scholar 

  23. Wazni OM, et al. Cryoballoon ablation as initial therapy for atrial fibrillation. New Engl J Med. 2021;384(4):316–24. https://doi.org/10.1056/NEJMoa2029554.

    Article  CAS  Google Scholar 

  24. Wilber DJ, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010;303(4):333–40. https://doi.org/10.1001/jama.2009.2029.

    Article  CAS  Google Scholar 

  25. Blandino A, et al. Long-term efficacy and safety of two different rhythm control strategies in elderly patients with symptomatic persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2013;24(7):731–8. https://doi.org/10.1111/jce.12126.

    Article  Google Scholar 

  26. Liu W, et al. The trend of change in catheter ablation versus antiarrhythmic drugs for the management of atrial fibrillation over time: a meta-analysis and meta-regression. J Geriatr Cardiol: JGC. 2018;15(6):441–50. https://doi.org/10.11909/j.issn.1671-5411.2018.06.011.

    Article  Google Scholar 

  27. Steinberg JS, et al. Thirty-second gold standard definition of atrial fibrillation and its relationship with subsequent arrhythmia patterns: analysis of a large prospective device database. Circ Arrhythm Electrophysiol. 2018;11(7):e006274. https://doi.org/10.1161/CIRCEP.118.006274.

    Article  Google Scholar 

  28. Calkins, Hugh, et al. HRS/EHRA/ECAS Expert Consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the .... Europace 2007;9.6: 335–379.

  29. Linz D, et al. Associations of obstructive sleep apnea with atrial fibrillation and continuous positive airway pressure treatment: a review. JAMA Cardiol. 2018;3(6):532–40. https://doi.org/10.1001/jamacardio.2018.0095.

    Article  Google Scholar 

  30. Turagam MK, et al. Assessment of catheter ablation or antiarrhythmic drugs for first-line therapy of atrial fibrillation: a meta-analysis of randomized clinical trials. JAMA Cardiol. 2021;6(6):697–705. https://doi.org/10.1001/jamacardio.2021.0852.

    Article  Google Scholar 

  31. Shi L-Z, et al. Effect of catheter ablation versus antiarrhythmic drugs on atrial fibrillation: a meta-analysis of randomized controlled trials. Exp Ther Med. 2015;10(2):816–22. https://doi.org/10.3892/etm.2015.2545.

    Article  Google Scholar 

  32. Khan AR, et al. Catheter ablation and antiarrhythmic drug therapy as first- or second-line therapy in the management of atrial fibrillation: systematic review and meta-analysis. Circ Arrhythm Electrophysiol. 2014;7(5):853–60. https://doi.org/10.1161/CIRCEP.114.001853.

    Article  CAS  Google Scholar 

  33. Hakalahti A, Biancari F, Nielsen JC, PekkaRaatikainen MJ. Radiofrequency ablation vs. antiarrhythmic drug therapy as first line treatment of symptomatic atrial fibrillation: systematic review and meta-analysis. EP Europace. 2015;17(3):370–8. https://doi.org/10.1093/europace/euu376.

    Article  Google Scholar 

  34. Calkins H, et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circ Arrhythm Electrophysiol. 2009;2(4):349–61. https://doi.org/10.1161/CIRCEP.108.824789.

    Article  CAS  Google Scholar 

  35. Ravi V, et al. Mortality benefit of catheter ablation versus medical therapy in atrial fibrillation: an RCT only meta-analysis. J Cardiovasc Electrophysiol. 2022;33(2):178–93. https://doi.org/10.1111/jce.15330.

    Article  Google Scholar 

  36. Khan SU, et al. The clinical benefits and mortality reduction associated with catheter ablation in subjects with atrial fibrillation: a systematic review and meta-analysis. JACC Clin Electrophysiol. 2018;4(5):626–35. https://doi.org/10.1016/j.jacep.2018.03.003.

    Article  Google Scholar 

  37. Maisel WH, Stevenson LW. Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol. 2003;91(6A):2D-8D. https://doi.org/10.1016/s0002-9149(02)03373-8.

    Article  Google Scholar 

  38. Wang TJ, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107(23):2920–5. https://doi.org/10.1161/01.CIR.0000072767.89944.6E.

    Article  Google Scholar 

  39. Patti G, et al. Thromboembolic risk, bleeding outcomes and effect of different antithrombotic strategies in very elderly patients with atrial fibrillation: a sub-analysis from the PREFER in AF (PREvention oF Thromboembolic Events-European Registry in Atrial Fibrillation). J Am Heart Assoc. 2017;6(7):e005657. https://doi.org/10.1161/JAHA.117.005657.

    Article  Google Scholar 

  40. Noseworthy PA, et al. Trends and predictors of readmission after catheter ablation for atrial fibrillation, 2009–2013. Am Heart J. 2015;170(3):483–9. https://doi.org/10.1016/j.ahj.2015.05.018.

    Article  Google Scholar 

  41. Baysal E, et al. Decreasing time between first diagnosis of paroxysmal atrial fibrillation and cryoballoon ablation positively affects long-term consequences. J Interv Card Electrophysiol: Int J Arrhythm Pacing. 2022. https://doi.org/10.1007/s10840-022-01167-3.

    Article  Google Scholar 

  42. Wu S, et al. Comparing the efficacy of catheter ablation strategies for persistent atrial fibrillation: a Bayesian analysis of randomized controlled trials. J Interv Card Electrophysiol: Int J Arrhythm Pacing. 2022. https://doi.org/10.1007/s10840-022-01246-5.

    Article  Google Scholar 

  43. Zhou X, et al. Comparative efficacy and safety of catheter ablation interventions for atrial fibrillation: comprehensive network meta-analysis of randomized controlled trials. J Interv Card Electrophysiol: Int J Arrhythm Pacing. 2021;62(1):199–211. https://doi.org/10.1007/s10840-020-00878-9.

    Article  Google Scholar 

  44. Cui L, et al. Comparison of higher-power and conventional power ablation of atrial fibrillation using contact force-sensing catheters: a systematic review and meta-analysis. J Interv Card Electrophysiol: Int J Arrhythm Pacing. 2021;62(1):1–7. https://doi.org/10.1007/s10840-021-00975-3.

    Article  Google Scholar 

  45. Anic A, et al. Pulsed field ablation: a promise that came true. Curr Opin Cardiol. 2021;36(1):5–9. https://doi.org/10.1097/HCO.0000000000000810.

    Article  Google Scholar 

  46. Maan A, Koruth J. Pulsed field ablation: a new paradigm for catheter ablation of arrhythmias. Curr Cardiol Rep. 2022;24(2):103–8. https://doi.org/10.1007/s11886-021-01630-z.

    Article  Google Scholar 

  47. Wijffels MCEF, Crijns HJGM. Rate versus rhythm control in atrial fibrillation. Cardiol Clin. 2004;22(1):63–9. https://doi.org/10.1016/s0733-8651(03)00112-7.

    Article  Google Scholar 

  48. Lu Z, et al. Atrial fibrillation begets atrial fibrillation: autonomic mechanism for atrial electrical remodeling induced by short-term rapid atrial pacing. Circ Arrhythm Electrophysiol. 2008;1(3):184–92. https://doi.org/10.1161/CIRCEP.108.784272.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Memorial Medical Center, Southern Illinois University School of Medicine, N 1st St, Springfield, IL, 62781, USA

    Radhika Deshpande, Prashanth Singanallur & Albert Botchway

  2. Cardiovascular Division, Southern Illinois University School of Medicine, Springfield, IL, USA

    Yasser AlKhadra & Mohamed Labedi

Authors
  1. Radhika Deshpande
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasser AlKhadra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Prashanth Singanallur
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Albert Botchway
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mohamed Labedi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

I certify that all authors listed above meet the authorship criteria and all authors participated and are in agreement with the manuscript.

Corresponding author

Correspondence to Radhika Deshpande.

Ethics declarations

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deshpande, R., AlKhadra, Y., Singanallur, P. et al. Outcomes of catheter ablation versus antiarrhythmic therapy in patients with atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol 65, 773–802 (2022). https://doi.org/10.1007/s10840-022-01365-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-022-01365-z

Keywords

Search

Navigation