Catheter Ablation and Anti-Arrhythmic Drug Therapy as First or Second Line Therapy in the Management of Atrial Fibrillation: A Systematic Review and Meta-Analysis
Background—The optimal management of atrial fibrillation (AF) remains unclear. We performed a meta-analysis of randomized controlled trials (RCT) to examine the safety and efficacy of catheter ablation (CA) as compared to anti-arrhythmic drug therapy (ADT) both as first or second line therapy for the maintenance of sinus rhythm in AF.
Methods and Results—Several databases were searched from inception through March 2014which yielded 11 studies with 1481 AF patients. The outcomes measured were recurrence of atrial tachyarrhythmia and the incidence of adverse events. A sub-group analysis was done to evaluate the efficacy of CA as first or second line therapy. There was recurrence of atrial tachyarrhythmia in 222 of 785 (28%) patients who underwent CA and in 451 of 696 (65%) patients who were on ADT (RR 0.40, 95% CI, 0.31−0.52, p = 0.00001). Sub-group analysis revealed a beneficial effect of CA both as a first line (RR 0.52, 95% CI, 0.30−0.91, p = 0.02) and as a second line (RR 0.37, 95% CI, 0.29−0.48, p<0.00001) therapeutic modality. There was a significantly higher incidence of major adverse events in the CA group compared with the ADT group (RR 2.04, 95% CI, 1.10 - 3.77, p = 0.02, I2 = 0%).
Conclusions—CA appears to be superior to ADT in drug naïve, resistant and intolerant patients with AF. However, it should be performed in carefully selected patients after weighing the risks and benefits of the procedure.
- Received March 17, 2014.
- Revision received May 15, 2014.
- Accepted June 23, 2014.