Address for correspondence:
Leenhapong Navaravong, MD
Division of Cardiovascular Medicine
University of Utah School of Medicine
30 N 1900 E, 4A-100
Salt Lake City, UT, 84132
Email: l.navaravong@hsc.utah.edu
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References: 22
Background: Recent randomized controlled trials (RCT) suggest
that ablation is superior to antiarrhythmic drugs (AAD) as an initial
therapy for paroxysmal atrial fibrillation (pAF) to prevent arrhythmia
recurrences. We performed an updated meta-analysis of RCTs, to include
recent data from cryoballoon-based ablation, and to compare
arrhythmia-free survival and adverse events between ablation and AAMs.
Methods: We searched MEDLINE and EMBASE from inception to
December 2020. We included RCT comparing patients with pAF undergoing
ablation or receiving AADs as an initial therapy. We combined data using
the random-effects model to calculate hazards ratio (HR) for
arrhythmia-free survival and odds ratio (OR) for adverse events.
Results: Five studies from 2005-2020 involving 985 patients
were included (495 patients and 490 patients underwent ablation and
medication as initial therapy, respectively). Patients who underwent
ablation had higher freedom from atrial tachyarrhythmias (AT) during the
12-24 months follow-up period (pooled HR=0.48, 95% CI:0.40-0.59,
p<0.001) (Figure 2). In a subgroup analysis of ablation method
used, both cryoablation group (pooled HR=0.49, 95% CI:0.38-0.64,
p<0.001) (Figure 2A) and radiofrequency ablation group (pooled
HR=0.47, 95%CI:0.35-0.64, p<0.001) (Figure 2B) showed
reduction in AT recurrence compared to AAD group. There were no
differences in adverse events including cerebrovascular accident,
pericardial effusion or tamponade, pulmonary vein stenosis, acute
coronary syndrome, deep vein thrombosis and pulmonary embolism, and
bradycardia requiring a pacemaker.
Conclusion: Catheter ablation (both cryoablation and
radiofrequency ablation) is superior to AAD as an initial therapy for
pAF in efficacy for reducing AT recurrences without a compromise in
adverse events.
Keywords: atrial fibrillation ablation; first line therapy; paroxysmal
atrial fibrillation