Efficacy and safety of curative catheter ablation for atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Its treatment is still widely debated due to the large variety of therapeutic options. Radiofrequency catheter ablation (RFCA) around pulmonary vein ostia and in left atrium has been proposed as a curative technique to treat AF and is now performed with increasing success worldwide. However, few randomised controlled trials (RCTs) are available. Some of these have been recently published and not yet included in meta-analyses. To address the efficacy and safety of RFCA for curative treatment of AF, we perform a systematic review, in order to provide a more precise estimate of post-procedural atrial tachyarrhythmias (ATs) recurrence, adverse effects and complications. Using electronic databases, we searched for RCTs comparing RFCA with anti-arrhythmic drugs for the management of AF. The efficacy end-point was freedom from ATs (including atrial fibrillation, atrial flutter and atrial tachycardia), following the procedure. The safety end-point was the rate complications and adverse events. The results are reported as relative risk (RR) and 95% confidence interval (CI), calculated using the RevMan software (The Cochrane Collaboration, Copenhagen, 2008). A total of 8 RCTs were identified, including 844 patients. Overall, 98 (23.2%) of 421 patients in the treatment group and 324 (76.6%) of 423 patients in the control group had ATs recurrence. Catheter ablation decreased ATs recurrence by 71% (RR = 0.29, 95% CI 0.20 to 0.41, p<0.00001, with random effects model). Fewer complications and adverse events were reported in the ablation group compared with the control group (RR = 0.72, 95% CI 0.40 to 1.30, p=0.28, with random effects model). In selected patients with AF, RFCA is a relatively efficacious and safe procedure for the curative treatment of AF. Even though the results of this systematic review favoUr ablation therapy, large, well-designed, multicenter RCTs are needed to confirm the efficacy and safety of RFCA for AF. Key words: Atrial fibrillation, randomised controlled trials, radiofrequency catheter ablation, anti-arrhythmic drugs, meta-analysis.