Catheter Ablation vs. Anti-Arrhythmic Drugs as First-Line Treatment in Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Background: Catheter ablation has become a well-established indication for long-term rhythm control in atrial fibrillation (AF) patients refractory to anti-arrhythmic drugs (AADs). Efficacy and safety of AF catheter ablation (AFCA) before AADs failure are, instead, questioned.Objective: The aim of t...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-05-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.664647/full |
| _version_ | 1818661967765700608 |
|---|---|
| author | Andrea Saglietto Fiorenzo Gaita Roberto De Ponti Gaetano Maria De Ferrari Matteo Anselmino |
| author_facet | Andrea Saglietto Fiorenzo Gaita Roberto De Ponti Gaetano Maria De Ferrari Matteo Anselmino |
| author_sort | Andrea Saglietto |
| collection | DOAJ |
| description | Background: Catheter ablation has become a well-established indication for long-term rhythm control in atrial fibrillation (AF) patients refractory to anti-arrhythmic drugs (AADs). Efficacy and safety of AF catheter ablation (AFCA) before AADs failure are, instead, questioned.Objective: The aim of the study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing first-line AFCA with AADs in symptomatic patients with paroxysmal AF.Methods: We performed a random-effects meta-analysis of binary outcome events comparing AFCA with AADs in rhythm control-naïve patients. The primary outcomes, also stratified by the type of ablation energy (radiofrequency or cryoenergy), were (1) recurrence of atrial tachyarrhythmias and (2) recurrence of symptomatic atrial tachyarrhythmias. The secondary outcomes included adverse events.Results: Six RCTs were included in the analysis. AFCA was associated with lower recurrences of atrial tachyarrhythmias [relative risk (RR) 0.58, 95% confidence interval (CI) 0.46–0.72], consistent across the two types of ablation energy (radiofrequency, RR 0.50, 95% CI 0.28–0.89; cryoenergy, RR 0.60, 95% CI 0.50–0.72; p-value for subgroup differences: 0.55). Similarly, AFCA was related to less symptomatic arrhythmic recurrences (RR 0.46, 95% CI 0.27–0.79). Overall, adverse events did not differ. A trend toward increased periprocedural cardiac tamponade or phrenic nerve palsy was observed in the AFCA group, while more atrial flutter episodes with 1:1 atrioventricular conduction and syncopal events were reported in the AAD group.Conclusions: First-line rhythm control therapy with AFCA, independent from the adopted energy source (radiofrequency or cryoenergy), reduces long-term arrhythmic recurrences in patients with symptomatic paroxysmal AF compared with AADs. |
| first_indexed | 2024-12-17T04:53:28Z |
| format | Article |
| id | doaj.art-434f13f1a7794cb3a1805ca73a27acb9 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-17T04:53:28Z |
| publishDate | 2021-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-434f13f1a7794cb3a1805ca73a27acb92022-12-21T22:02:48ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-05-01810.3389/fcvm.2021.664647664647Catheter Ablation vs. Anti-Arrhythmic Drugs as First-Line Treatment in Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Clinical TrialsAndrea Saglietto0Fiorenzo Gaita1Roberto De Ponti2Gaetano Maria De Ferrari3Matteo Anselmino4Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, ItalyCardiology Unit, J Medical, Turin, ItalyDepartment of Medicine and Surgery, University of Insubria, Varese, ItalyDivision of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, ItalyDivision of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, ItalyBackground: Catheter ablation has become a well-established indication for long-term rhythm control in atrial fibrillation (AF) patients refractory to anti-arrhythmic drugs (AADs). Efficacy and safety of AF catheter ablation (AFCA) before AADs failure are, instead, questioned.Objective: The aim of the study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing first-line AFCA with AADs in symptomatic patients with paroxysmal AF.Methods: We performed a random-effects meta-analysis of binary outcome events comparing AFCA with AADs in rhythm control-naïve patients. The primary outcomes, also stratified by the type of ablation energy (radiofrequency or cryoenergy), were (1) recurrence of atrial tachyarrhythmias and (2) recurrence of symptomatic atrial tachyarrhythmias. The secondary outcomes included adverse events.Results: Six RCTs were included in the analysis. AFCA was associated with lower recurrences of atrial tachyarrhythmias [relative risk (RR) 0.58, 95% confidence interval (CI) 0.46–0.72], consistent across the two types of ablation energy (radiofrequency, RR 0.50, 95% CI 0.28–0.89; cryoenergy, RR 0.60, 95% CI 0.50–0.72; p-value for subgroup differences: 0.55). Similarly, AFCA was related to less symptomatic arrhythmic recurrences (RR 0.46, 95% CI 0.27–0.79). Overall, adverse events did not differ. A trend toward increased periprocedural cardiac tamponade or phrenic nerve palsy was observed in the AFCA group, while more atrial flutter episodes with 1:1 atrioventricular conduction and syncopal events were reported in the AAD group.Conclusions: First-line rhythm control therapy with AFCA, independent from the adopted energy source (radiofrequency or cryoenergy), reduces long-term arrhythmic recurrences in patients with symptomatic paroxysmal AF compared with AADs.https://www.frontiersin.org/articles/10.3389/fcvm.2021.664647/fullatrial fibrillationcatheter ablationrhythm controlanti-arrhythmic drugsside effects |
| spellingShingle | Andrea Saglietto Fiorenzo Gaita Roberto De Ponti Gaetano Maria De Ferrari Matteo Anselmino Catheter Ablation vs. Anti-Arrhythmic Drugs as First-Line Treatment in Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials Frontiers in Cardiovascular Medicine atrial fibrillation catheter ablation rhythm control anti-arrhythmic drugs side effects |
| title | Catheter Ablation vs. Anti-Arrhythmic Drugs as First-Line Treatment in Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials |
| title_full | Catheter Ablation vs. Anti-Arrhythmic Drugs as First-Line Treatment in Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials |
| title_fullStr | Catheter Ablation vs. Anti-Arrhythmic Drugs as First-Line Treatment in Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials |
| title_full_unstemmed | Catheter Ablation vs. Anti-Arrhythmic Drugs as First-Line Treatment in Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials |
| title_short | Catheter Ablation vs. Anti-Arrhythmic Drugs as First-Line Treatment in Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials |
| title_sort | catheter ablation vs anti arrhythmic drugs as first line treatment in symptomatic paroxysmal atrial fibrillation a systematic review and meta analysis of randomized clinical trials |
| topic | atrial fibrillation catheter ablation rhythm control anti-arrhythmic drugs side effects |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2021.664647/full |
| work_keys_str_mv | AT andreasaglietto catheterablationvsantiarrhythmicdrugsasfirstlinetreatmentinsymptomaticparoxysmalatrialfibrillationasystematicreviewandmetaanalysisofrandomizedclinicaltrials AT fiorenzogaita catheterablationvsantiarrhythmicdrugsasfirstlinetreatmentinsymptomaticparoxysmalatrialfibrillationasystematicreviewandmetaanalysisofrandomizedclinicaltrials AT robertodeponti catheterablationvsantiarrhythmicdrugsasfirstlinetreatmentinsymptomaticparoxysmalatrialfibrillationasystematicreviewandmetaanalysisofrandomizedclinicaltrials AT gaetanomariadeferrari catheterablationvsantiarrhythmicdrugsasfirstlinetreatmentinsymptomaticparoxysmalatrialfibrillationasystematicreviewandmetaanalysisofrandomizedclinicaltrials AT matteoanselmino catheterablationvsantiarrhythmicdrugsasfirstlinetreatmentinsymptomaticparoxysmalatrialfibrillationasystematicreviewandmetaanalysisofrandomizedclinicaltrials |