Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials

Abstract Background Recent randomized controlled trials (RCTs) suggest that ablation is superior to antiarrhythmic drugs (AADs) 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...

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Autores principales:	Jakrin Kewcharoen, Narut Prasitlumkum, Ronpichai Chokesuwattanaskul, Ruiyang Yi, Krit Jongnarangsin, Thomas J. Bunch, Ravi Ranjan, Leenhapong Navaravong
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	atrial fibrillation ablation first‐line therapy paroxysmal atrial fibrillation Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/131671c1fb6c4000ab19cf8b95454ef3
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spelling	oai:doaj.org-article:131671c1fb6c4000ab19cf8b95454ef32021-12-02T08:25:11ZAblation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials1883-21481880-427610.1002/joa3.12641https://doaj.org/article/131671c1fb6c4000ab19cf8b95454ef32021-12-01T00:00:00Zhttps://doi.org/10.1002/joa3.12641https://doaj.org/toc/1880-4276https://doaj.org/toc/1883-2148Abstract Background Recent randomized controlled trials (RCTs) suggest that ablation is superior to antiarrhythmic drugs (AADs) 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 AADs. 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 to 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 (ATs) during the 12‐24 months follow‐up period (pooled HR = 0.48, 95% CI: 0.40‐0.59, P < .001). In a subgroup analysis of ablation method used, both cryoablation group (pooled HR = 0.49, 95% CI: 0.38‐0.64, P < .001) and radiofrequency ablation group (pooled HR = 0.47, 95%CI: 0.35‐0.64, P < .001) showed reduction in AT recurrence compared with 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.Jakrin KewcharoenNarut PrasitlumkumRonpichai ChokesuwattanaskulRuiyang YiKrit JongnarangsinThomas J. BunchRavi RanjanLeenhapong NavaravongWileyarticleatrial fibrillation ablationfirst‐line therapyparoxysmal atrial fibrillationDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of Arrhythmia, Vol 37, Iss 6, Pp 1448-1458 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation ablation first‐line therapy paroxysmal atrial fibrillation Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	atrial fibrillation ablation first‐line therapy paroxysmal atrial fibrillation Diseases of the circulatory (Cardiovascular) system RC666-701 Jakrin Kewcharoen Narut Prasitlumkum Ronpichai Chokesuwattanaskul Ruiyang Yi Krit Jongnarangsin Thomas J. Bunch Ravi Ranjan Leenhapong Navaravong Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials
description	Abstract Background Recent randomized controlled trials (RCTs) suggest that ablation is superior to antiarrhythmic drugs (AADs) 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 AADs. 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 to 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 (ATs) during the 12‐24 months follow‐up period (pooled HR = 0.48, 95% CI: 0.40‐0.59, P < .001). In a subgroup analysis of ablation method used, both cryoablation group (pooled HR = 0.49, 95% CI: 0.38‐0.64, P < .001) and radiofrequency ablation group (pooled HR = 0.47, 95%CI: 0.35‐0.64, P < .001) showed reduction in AT recurrence compared with 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.
format	article
author	Jakrin Kewcharoen Narut Prasitlumkum Ronpichai Chokesuwattanaskul Ruiyang Yi Krit Jongnarangsin Thomas J. Bunch Ravi Ranjan Leenhapong Navaravong
author_facet	Jakrin Kewcharoen Narut Prasitlumkum Ronpichai Chokesuwattanaskul Ruiyang Yi Krit Jongnarangsin Thomas J. Bunch Ravi Ranjan Leenhapong Navaravong
author_sort	Jakrin Kewcharoen
title	Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials
title_short	Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials
title_full	Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials
title_fullStr	Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials
title_full_unstemmed	Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials
title_sort	ablation versus medication as initial therapy for paroxysmal atrial fibrillation: an updated meta‐analysis of randomized controlled trials
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/131671c1fb6c4000ab19cf8b95454ef3
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Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials

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