Persistent atrial fibrillation: A systematic review and meta-analysis of invasive strategies

Autor: E R Meulendijks, J. Neefs, Wim-Jan van Boven, Joris R. de Groot, Nicoline W.E. van den Berg, Antoine H.G. Driessen, Sébastien P.J. Krul, Wouter R. Berger, Jacqueline Limpens
Přispěvatelé: Graduate School, ACS - Atherosclerosis & ischemic syndromes, ACS - Heart failure & arrhythmias, Cardiology, ACS - Amsterdam Cardiovascular Sciences
Rok vydání: 2019
Předmět:
medicine.medical_specialty
medicine.medical_treatment
Catheter Ablation/adverse effects
Catheter ablation
030204 cardiovascular system & hematology
law.invention
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Randomized Controlled Trials as Topic/methods
Randomized controlled trial
law
Atrial Fibrillation
Atrial Fibrillation/diagnosis
Minimally Invasive Surgical Procedures/adverse effects
Minimally Invasive Surgical Procedures
Humans
Medicine
030212 general & internal medicine
Adverse effect
Stroke
Randomized Controlled Trials as Topic
business.industry
Postoperative Complications/diagnosis
medicine.disease
Surgery
Catheter
Treatment Outcome
Meta-analysis
Persistent atrial fibrillation
Catheter Ablation
Cardiology and Cardiovascular Medicine
business
Surgical ablation
Zdroj: International journal of cardiology, 278, 137-143. Elsevier Ireland Ltd
International Journal of Cardiology, 278, 137-143. Elsevier Ireland Ltd
ISSN: 0167-5273
DOI: 10.1016/j.ijcard.2018.11.127
Popis: Background Persistent atrial fibrillation (AF) is associated with higher stroke and mortality risk than paroxysmal AF (pAF). Outcomes of catheter or surgical ablation are worse in patients with persistent AF than in pAF, and the optimal invasive rhythm control strategy has not been established. Purpose We provide a contemporary systematic overview on efficacy and safety of catheter and minimally-invasive surgical ablation for persistent AF. Methods We systematically searched EMBASE, MEDLINE and CENTRAL from inception to July 2018 for randomized trials on surgical and catheter ablation, and included all study arms on persistent AF. Outcome was AF freedom after ≥12 months follow-up without AAD use. Random effects models were used to calculate proportions with 95%-confidence intervals. Safety consisted of adverse events during treatment and follow-up. Results We included 6 studies on minimally-invasive surgical ablation and 56 on catheter ablation, involving 7624 patients with persistent AF. AF Freedom at 12 months was 69% (95%CI 64–74%) after surgical and 51% (95%CI 46–56%) after catheter ablation. More severe procedural adverse events occurred with surgery than with catheter ablation. Conclusions In persistent AF patients, minimally-invasive surgical ablation is associated with more procedural complications, but higher AF freedom. As adverse events after surgical ablation appear more severe than in catheter ablation, a patient-tailored therapy choice is warranted.
Databáze: OpenAIRE
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