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Meta-Analysis
. 2016 Jun;22(6):729-37.
doi: 10.1093/icvts/ivw027. Epub 2016 Feb 23.

Epicardial thoracoscopic ablation versus endocardial catheter ablation for management of atrial fibrillation: a systematic review and meta-analysis

Hyun Jung Kim  1 , Jin Suk Kim  2 , Tae Sik Kim  3
Affiliations
Meta-Analysis

Epicardial thoracoscopic ablation versus endocardial catheter ablation for management of atrial fibrillation: a systematic review and meta-analysis

Hyun Jung Kim et al. Interact Cardiovasc Thorac Surg. 2016 Jun.

Abstract

Objectives: In the treatment of patients with atrial fibrillation (AF), the efficacy and safety of epicardial thoracoscopic ablation (TA) versus endocardial catheter ablation (CA) using radiofrequency energy remains unclear. This meta-analysis was performed to assess the efficacy and safety of each ablation technique using a pooled comparative analysis.

Methods: Studies comparing the efficacy and safety of TA and CA were identified by searching electronic databases. Those that reported patients' freedom from atrial arrhythmia and significant side effects were included.

Results: Three randomized controlled trials (RCTs) and two retrospective cohort studies with a total of 587 patients were included in the meta-analysis (273 patients underwent TA and 314 patients underwent CA). The proportion of patients who were free of atrial arrhythmia without antiarrhythmic drugs during 12 months of follow-up was significantly higher after TA than after CA in the RCTs [P < 0.001; relative risk (RR), 1.77; 95% confidence interval (CI), 1.34-2.32] and in the retrospective cohort studies (P = 0.010; RR, 1.68; 95% CI, 1.12-2.51). The incidence of significant side effects during the post-procedural period was significantly higher in the TA group than in the CA group in both the RCT (P = 0.007; RR, 7.23; 95% CI, 1.71-30.49) and the retrospective cohort studies (P = 0.020; RR, 4.39; 95% CI, 1.33-14.46).

Conclusions: Based on the available data, TA was found to be more effective than CA in achieving freedom from atrial arrhythmia; however, TA had a higher rate of immediate post-procedural complications than CA.

Keywords: Atrial fibrillation; Catheter ablation; Meta-analysis; Thoracoscopy.

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Figures

Figure 1:
Figure 1:
Study search and selection process.
Figure 2:
Figure 2:
Freedom from atrial fibrillation without antiarrhythmic drugs in the randomized controlled studies (A) at 6 and 12 months of follow-up and retrospective cohort studies (B) after 12 months of follow-up, comparing TA with CA. TA: thoracoscopic ablation; CA: catheter ablation; CI: confidence interval; M-H: Mantel–Haenszel estimation method; random: random-effects model.
Figure 3:
Figure 3:
Freedom from atrial fibrillation with antiarrhythmic drugs in the randomized controlled studies (A) at 6 and 12 months of follow-up and retrospective cohort studies (B) after 12 months of follow-up, comparing TA with CA. TA: thoracoscopic ablation; CA: catheter ablation; CI: confidence interval; M-H: Mantel–Haenszel estimation method; random: random-effects model.
Figure 4:
Figure 4:
Significant adverse events during the periprocedural period (A) and after 12 months of follow-up (B), comparing TA with CA. TA: thoracoscopic ablation; CA: catheter ablation; RCT: randomized controlled trial; RetrspCohrt: retrospective cohort study; CI: confidence interval; M-H: Mantel–Haenszel estimation method; random: random-effects model.
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References

    1. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J et al. . Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 2005;111:1100–5. - PubMed
    1. Nielsen JC, Johannessen A, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O et al. . Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med 2012;367:1587–95. - PubMed
    1. Wolf RK, Schneeberger EW, Osterday R, Miller D, Merrill W, Flege JB Jr et al. . Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg 2005;130:797–802. - PubMed
    1. Sagbas E, Akpinar B, Sanisoglu I, Caynak B, Tamtekin B, Oral K et al. . Video-assisted bilateral epicardial pulmonary vein isolation for the treatment of lone atrial fibrillation. Ann Thorac Surg 2007;83:1724–30. - PubMed
    1. Kron J, Kasirajan V, Wood MA, Kowalski M, Han FT, Ellenbogen KA. Management of recurrent atrial arrhythmias after minimally invasive surgical pulmonary vein isolation and ganglionic plexi ablation for atrial fibrillation. Heart Rhythm 2010;7:445–51. - PubMed