Efficacy and safety of catheter ablation versus antiarrhythmic drugs for atrial fibrillation: a meta-analysis of randomized trials
| Autor: | Alessandro Fontanelli, R. Ometto, Mariemma Paccanaro, Carlo Bonanno, Luigi La Vecchia |
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| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Management of atrial fibrillation Catheter ablation law.invention Pulmonary vein Randomized controlled trial law Internal medicine Atrial Fibrillation medicine Humans cardiovascular diseases Atrial tachycardia Randomized Controlled Trials as Topic business.industry Atrial fibrillation General Medicine medicine.disease Relative risk Anesthesia cardiovascular system Cardiology Catheter Ablation medicine.symptom Cardiology and Cardiovascular Medicine business Anti-Arrhythmia Agents Atrial flutter |
| Zdroj: | Journal of cardiovascular medicine (Hagerstown, Md.). 11(6) |
| ISSN: | 1558-2035 |
| Popis: | Atrial fibrillation is the most common arrhythmia in clinical practice. Its treatment is still widely debated due to the large variety of therapeutic options. Radiofrequency catheter ablation (RFCA) around pulmonary vein ostia and in the left atrium has been proposed as a technique to cure atrial fibrillation and is now performed with increasing success worldwide. However, few randomized controlled trials (RCTs) are available. Some of these have been published recently and are not yet included in meta-analyses.We conducted a meta-analysis to summarize the current evidence base for the efficacy and safety of RFCA in patients with atrial fibrillation.We searched electronic databases for relevant RCTs comparing RFCA with antiarrhythmic drugs for the management of atrial fibrillation. Recurrence of any atrial tachyarrhythmia (including atrial fibrillation, atrial flutter and atrial tachycardia) and rate of complications and adverse events were the end-points of the analysis. The results are reported as relative risk and 95% confidence interval, calculated using RevMan 5.A total of eight RCTs were identified including 844 patients. Overall, 98 (23.2%) of 421 patients in the treatment group and 324 (76.6%) of 423 patients in the control group had atrial tachyarrhythmia recurrence. RFCA decreased atrial tachyarrhythmia recurrence by 71% (relative risk 0.29, 95% confidence interval 0.20-0.41, P0.00001, with random effects model). Fewer complications and adverse events were reported in the ablation group compared with the control group (relative risk 0.72, 95% confidence interval 0.40-1.30, P = 0.28, with random effects model).In selected patients with atrial fibrillation, RFCA is a relatively effective and well-tolerated procedure to cure atrial fibrillation. Even though the results of our systematic review favour ablation therapy, large, well-designed RCTs are needed to confirm the efficacy and safety of RFCA for the management of atrial fibrillation. |
| Databáze: | OpenAIRE |
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