Antiarrhythmic drug therapy and catheter ablation in patients with paroxysmal or persistent atrial fibrillation: a systematic review and meta-analysis.

Autor: Chander S; Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA. chander2@buffalo.edu., Kumari R; Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA., Luhana S; Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA., Shiwlani S; Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA., Parkash O; Department of Medicine, Montefiore Medical Centre, Wakefield, NY, USA., Sorath F; Department of Anesthesiology, Dow University Health Sciences, Karachi, Pakistan., Wang HY; Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA., Tan S; Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA., Rahaman Z; Department of Medicine, University at Buffalo, Buffalo, NY, USA., Mohammed YN; Department of Medicine, Western Michigan University, Kalamazoo, WV, USA., Lohana AC; Department of Medicine, WVU, Camden Clark Medical Centre, Parkersburg, WV, USA., Sakshi F; Department of Medicine, Piedmont Augusta Hospital, Augusta, GA, USA., Vaish E; Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA., Sadarat F; Department of Medicine, University at Buffalo, Buffalo, NY, USA.
Jazyk: angličtina
Zdroj: BMC cardiovascular disorders [BMC Cardiovasc Disord] 2024 Jun 25; Vol. 24 (1), pp. 321. Date of Electronic Publication: 2024 Jun 25.
DOI: 10.1186/s12872-024-03983-z
Abstrakt: Background: Catheter ablation and antiarrhythmic drug therapy are utilized for rhythm control in atrial fibrillation (AF), but their comparative effectiveness, especially with contemporary treatment modalities, remains undefined. We conducted a systematic review and meta-analysis contrasting current ablation techniques against antiarrhythmic medications for AF.
Methods: We searched PubMed, SCOPUS, Cochrane CENTRAL, and Web of Science until November 2023 for randomized trials comparing AF catheter ablation with antiarrhythmics, against antiarrhythmic drug therapy alone, reporting outcomes for > 6 months. Four investigators extracted data and appraised risk of bias (ROB) with ROB 2 tool. Meta-analyses estimated pooled efficacy and safety outcomes using R software.
Results: Twelve trials (n = 3977) met the inclusion criteria. Catheter ablation was associated with lower AF recurrence (relative risk (RR) = 0.44, 95%CI (0.33, 0.59), P ˂ 0.0001) and hospitalizations (RR = 0.44, 95%CI (0.23, 0.82), P = 0.009) than antiarrhythmic medications. Catheter ablation also improved the physical quality of life component score (assessed by a 36-item Short Form survey) by 7.61 points (95%CI -0.70-15.92, P = 0.07); but, due to high heterogeneity, it was not statistically significant. Ablation was significantly associated with higher procedural-related complications [RR = 15.70, 95%CI (4.53, 54.38), P < 0.0001] and cardiac tamponade [RR = 9.22, 95%CI (2.16, 39.40), P = 0.0027]. All-cause mortality was similar between the two groups.
Conclusions: For symptomatic AF, upfront catheter ablation reduces arrhythmia and hospitalizations better than continued medical therapy alone, albeit with moderately more adverse events. Careful patient selection and risk-benefit assessment are warranted regarding the timing of ablation.
(© 2024. The Author(s).)
Databáze: MEDLINE
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