Medical treatment

Comparing catheter ablation on difficult outcomes versus medical treatment for patients with atrial fibrillation: a meta-analysis of randomized controlled trials with trial sequential analysis

This article was originally published here

PLoS One. 2022 Jan 19;17(1):e0262702. doi: 10.1371/journal.pone.0262702. eCollection 2022.


BACKGROUND: The prevailing opinion is that ablation does not reduce the incidence of stroke and death in atrial fibrillation (AF), and guidelines suggest that long-term anticoagulation is needed after ablation , regardless of the success of the procedure. We performed a meta-analysis of recent randomized controlled trials (RCTs) to test whether ablation versus drugs reduced the incidence of stroke and death.

METHODS: We systematically searched the PubMed, Embase and Cochrane Central Register of Controlled Trials databases for RCTs of catheter ablation of AF versus medical therapy (MT). Relative risk (RR) and weighted mean difference (WMD) with 95% CI were calculated using a random-effects model. Trial sequential analysis (TSA) was used to further validate the reliability of the primary outcomes.

RESULTS: Seventeen RCTs were included, including 5258 patients (CA, n=2760; MT, n=2498). Compared to medical treatment, CA was associated with a reduction in stroke/transient ischemic attacks (TIA) (p=0.035; RR=0.61 [95% CI, 0.386 to 0.965]; I2 = 0.0%) and death (p = 0.004; RR = 0.7 [95% CI, 0.55 to 0.89]; I2 = 0.0%). CA was associated with improved left ventricular ejection fraction (LVEF) (p=0.000; WMD=5.39 [95% CI, 2.45 to 8.32]; I2 = 84.4%) and rate of maintenance of sinus rhythm (SR) (p = 0.000; RR = 3.55 [95% CI, 2.34 to 5.40]; I2 = 76.7%).

CONCLUSIONS: AC for AF had more favorable outcomes in terms of stroke/TIA, death, change in LVEF and maintenance of SR at end of follow-up compared to TM. Furthermore, the TSA results supported this conclusion.

PMID:35045127 | DOI:10.1371/journal.pone.0262702