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Long-Term Outcomes and Improvements in Quality of Life in Patients with Atrial Fibrillation Treated with Catheter Ablation vs. Antiarrhythmic Drugs

American Journal of Cardiovascular Drugs volume 21, pages 299–320 (2021)Cite this article

Abstract

Background

Catheter ablation (CA) is a recognized first-line treatment for atrial fibrillation (AF) in selected patients; however, the differences between CA and antiarrhythmic drugs (AADs) in terms of long-term outcomes and quality of life (QoL) have not often been compared.

Objectives

We performed a meta-analysis of randomized controlled trials (RCTs) to compare long-term outcomes and QoL with CA and AADs in the treatment of AF.

Methods

We searched the MEDLINE database for English-language RCTs of CA or AADs in AF from 1 January 2005 to 30 October 2019 with no other restrictions. We included studies that reported sample sizes and the long-term outcomes of interest as well as sample size, mean ± standard deviation or 95% confidence intervals (CIs) for QoL outcomes with CA and AADs.

Results

We identified 20 RCTs involving 5425 participants. Compared with patients who received only AADs, patients receiving CA had a significantly decreased risk of all-cause death (relative risk [RR] 0.72; 95% CI 0.58–0.90) and cardiovascular hospitalization (RR 0.85; 95% CI 0.79–0.91). We found a significant increase in the risk of cardiac tamponade (RR 5.86; 95% CI 1.77–19.44) but no difference in the risk of heart failure, stroke or transient ischemic attack, atrial tachycardia, bleeding or hematoma, and pulmonary vein stenosis. For long-term QoL after treatment, both therapies resulted in improved scores on the Medical Outcomes Study 36-Item Short Form Survey (SF-36): weighted mean differences (WMDs) for the physical component score (PCS) were 5.89 for CA and 4.26 for AADs and for the mental component score (MCS) were 7.12 for CA and 5.06 for AADs. At the end of follow-up, groups receiving CA had significantly higher scores in both areas. The change in PCS and MCS between baseline and end of follow-up was also significantly higher in the CA groups: WMD 1.51 for change in PCS and 1.49 for change in MCS. All eight SF-36 subscale scores improved for patients receiving CA, whereas patients receiving AADs recorded no improvement in the general health and bodily pain subscales. At the end of follow-up, CA groups had significantly higher scores than AAD groups in the following subscales: physical functioning, role limitations due to physical health problems, bodily pain, general health, vitality, and role limitations due to emotional problems.

Conclusions

In the treatment of AF, CA appeared to be superior to AADs, decreasing the risk of all-cause death and cardiovascular hospitalization and improving the long-term QoL of patients with AF. CA was better tolerated and more effective than pharmacological therapy and allowed for improved QoL.

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Author notes

  1. Zi-Heng Zheng, Jun Fan and Cheng-Cheng Ji contributed equally.

Affiliations

  1. Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Rd II, Guangzhou, 510080, China

    Zi-Heng Zheng, Jun Fan, Cheng-Cheng Ji, Yun-Jiu Cheng, Xu-Miao Chen, Jing-Zhou Jiang & Su-Hua Wu

  2. Key Laboratory of Assisted Circulation, NHC, Guangzhou, China

    Zi-Heng Zheng, Jun Fan, Cheng-Cheng Ji, Yun-Jiu Cheng, Xu-Miao Chen, Jing-Zhou Jiang & Su-Hua Wu

  3. Department of Cardiology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, No. 1 Panfu road, Guangzhou, 510180, China

    Jun Fan

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  1. Zi-Heng Zheng
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Correspondence to Su-Hua Wu.

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Funding

No external funding was used in the preparation of this manuscript. This study was supported by grants from the National Natural Science Foundation of China (nos. 81370285 and 81970206), the Guangdong Natural Science Foundation (2019A1515010269), and the Guangzhou City Science and Technology key program (no. 201508020057) to Dr. Wu. No external funding was used in the preparation of this manuscript.

Conflict of interest

Zi-Heng Zheng, Jun Fan, Cheng-Cheng Ji, Yun-Jiu Cheng, Xu-Miao Chen, Jing-Zhou Jiang, and Su-Hua Wu have no potential conflicts of interest that might be relevant to the contents of this manuscript.

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Author Contributions

WSH and ZZH made substantial contributions to the design of the present study; ZZH, FJ, JCC, WSH, JJZ, CYJ, CXM analyzed the data; ZZH, FJ, JCC, WSH, CYJ wrote the manuscript. All authors have read and approved the final version of the manuscript.

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Zheng, ZH., Fan, J., Ji, CC. et al. Long-Term Outcomes and Improvements in Quality of Life in Patients with Atrial Fibrillation Treated with Catheter Ablation vs. Antiarrhythmic Drugs. Am J Cardiovasc Drugs 21, 299–320 (2021). https://doi.org/10.1007/s40256-020-00435-9

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