Higher arrythmia recurrence, fewer complications seen in catheter vs. surgical AF ablation
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Adults with atrial fibrillation were less likely to experience AF recurrence but more likely to experience major complications when undergoing surgical compared with catheter ablation, according to data from a meta-analysis.
Pooled meta-analysis results stratified by adverse events showed no significant differences in risk for cerebrovascular accident, bleeding, infection or pericardial effusion in catheter ablation compared with surgical ablation. However, when combined total major adverse events were compared, catheter ablation had a lower total major adverse event rate.
“Percutaneous electrical isolation of the pulmonary veins by catheter ablation is an effective treatment modality for AF and is indicated in drug-refractory paroxysmal and persistent AF,” Win-Kuang Shen, MD, of the departments of electrophysiology and cardiovascular diseases at Mayo Clinic in Phoenix, and colleagues wrote. “However, the European Society of Cardiology guidelines for the management of AF describe that the role of surgical AF ablation is considered for patients who failed catheter ablation in the past or as a primary management option for patients with symptomatic and drug-refractory persistent AF. Both ablation and surgical strategies have been shown to reduce AF burden significantly.”
Shen and colleagues analyzed data from six randomized controlled trials with 511 patients with AF (79% refractory paroxysmal; mean age, 57 years) with 263 catheter ablations and 248 surgical ablations. Studies compared video-assisted thoracoscopic and catheter radiofrequency pulmonary vein ablation conducted from November 2013 to December 2020.
Researchers found that catheter ablation was associated with increased atrial arrhythmia recurrence when compared with surgical ablation, with a pooled RR of 1.85 (95% CI, 1.44-2.39; P < .001; I2 = 0%). However, catheter ablation was associated with fewer total major adverse events vs. surgical ablation, with a pooled RR of 0.29 (95% CI, 0.16-0.53; P < .001; I2 = 0%).
In subgroup analysis, catheter ablation was associated with increased AF recurrence in refractory paroxysmal AF when compared with surgical ablation, with a pooled RR of 2.47 (95% CI, 1.31-4.65; P = .005; I2 = 0%) but not in persistent AF (RR = 1.09; 95% CI, 0.6-2; P = .773).
Procedure time was significantly longer in the surgical group compared with the catheter ablation group, with a weighted mean difference of 40.5 minutes (95% CI, 18.9-62; P = .025). Additionally, hospitalization duration was longer in the surgical group vs. the catheter group, with a weighted mean difference of 5 days (95% CI, 3.3-6.6; P < .001).
“Our study suggests that surgical ablation can effectively reduce AF recurrence in refractory paroxysmal AF but the benefit in patients with persistent AF is unclear,” the researchers wrote. “Procedural complications were more common in surgical ablation, in addition to longer procedural time and hospital stays. More studies and alternative ablation strategies investigation in persistent AF are warranted.”
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