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Ablation appears superior to rhythm control drugs in patients with nonparoxysmal AF
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Among patients with nonparoxysmal atrial fibrillation, radiofrequency catheter ablation appears to be superior to antiarrhythmic medications in terms of freedom from atrial arrhythmias, reduction of need for cardioversion and reduction in hospital admission for cardiac causes, according to recent findings.
In the systematic review, researchers queried the Cochrane Central Register of Controlled Trials, Ovid Medline, Ovid Embase, clinical trial registries and the Health Technology Assessment Database from their commencement to April 1, 2016. They identified three randomized trials (n = 261; mean age, 60 years) that compared radiofrequency catheter ablation (RFCA) or surgical ablation (n = 159) vs. heart rhythm medication (n = 102) in patients with nonparoxysmal AF, regardless of any simultaneous underlying heart conditions. Follow-up for the three studies was a minimum of 12 months.
The researchers used a fixed-effects model to calculate RRs with 95% CIs for dichotomous data in studies with low heterogeneity (I2 ≤ 40%) and a random-effects model when heterogeneity was moderate or significant (I2 > 40%).
They found that the identified studies had low or unclear risk of bias across several areas, with a lack a precision in reported outcomes attributed to low event rates.
Based on the evidence from the studies, RFCA yielded superior results vs. antiarrhythmic drugs in terms of the following: freedom from atrial arrhythmias (RR = 1.84; 95% CI, 1.17-2.88; three studies; 261 patients; low-quality evidence), decreasing the need for cardioversion (RR = 0.62; 95% CI, 0.47-0.82; three studies; 261 participants; moderate-quality evidence) and decreasing hospitalizations due to cardiac causes (RR = 0.27; 95% CI, 0.1-0.72; two studies; 216 participants; low-quality evidence) at 12 months.
Considerable ambiguity was observed in terms of the effects of RFCA on significant bradycardia or need for a pacemaker (RR = 0.2; 95% CI, 0.02-1.63; three studies; 261 participants; low-quality evidence) and periprocedural complications/other safety outcomes (RR = 0.94; 95% CI, 0.16-5.68; three studies; 261 participants; very low-quality evidence).
In people with nonparoxysmal [AF], evidence suggests a superiority of RFCA to antiarrhythmic drugs in achieving freedom from atrial arrhythmias, reducing the need for cardioversion and reducing cardiac-related hospitalizations,” the researchers wrote. “There was uncertainty surrounding the effect of RFCA with significant bradycardia, periprocedural complications and other safety outcomes. Evidence should be interpreted with caution, as event rates were low and quality of evidence ranged from moderate to very low.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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