Catheter Ablation of Paroxysmal Atrial Fibrillation and Disease Progression: Magnitude of the anti-progression effect and role of intervention timing.

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Recent randomized controlled trials(RCT) have shown that catheter ablation of paroxysmal atrial fibrillation(AF) is associated with a lower incidence of progression to persistent AF compared to the use of antiarrhythmic drug(AAD) therapy. This meta-analysis aimed to investigate the magnitude of the anti-progression effect of catheter ablation, as well as the effect of intervention timing. MEDLINE/EMBASE databases were searched until April 1st 2024 for RCTs comparing catheter ablation and AAD therapy for the treatment of paroxysmal AF and reporting the rate of progression to persistent AF at 3 years (PROSPERO CRD42024534288). A total of 1,287 references were retrieved, of which 5 RCTs met inclusion criteria. The rate of progression to persistent AF was 8.3% (95%CI: 5.4-11.2, I2= 67.2%) at 3 years. The 3-year rate of progression to persistent AF was significantly lower in patients randomized to catheter ablation (1.8%; 95%CI: 0.3-3.3, I2= 0%) when compared to AAD (14.9%; 95%CI: 9.3-20.5, I2= 71.9%); representing a risk ratio of progression to persistent AF at 3 years of 0.15 (95%CI: 0.08-0.28, I2= 0%, p<0.001) for catheter ablation vs. AAD therapy. Catheter ablation appeared similarly efficient in reducing AF progression when used as first-line or non-first line therapy (RR=0.19 95%CI: 0.07-0.48 and RR=0.13, 95%CI: 0.05-0.29, respectively, pinteraction=0.551). The risk of progression to persistent AF at 3 years appears to be reduced by almost 7-fold in patients with paroxysmal AF treated using catheter ablation compared to patients treated using AAD therapy, regardless of the timing of the intervention.