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. 2016 Apr;2(2):170-180.
doi: 10.1016/j.jacep.2015.10.003. Epub 2015 Nov 10.

Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation: Meta-Analysis of Quality of Life, Morbidity, and Mortality

Konstantinos C Siontis  1 , John P A Ioannidis  2 , George D Katritsis  3 , Peter A Noseworthy  4 , Douglas L Packer  4 , John D Hummel  5 , Pierre Jais  6 , Rungroj Krittayaphong  7 , Llius Mont  8 , Carlos A Morillo  9 , Jens Cosedis Nielsen  10 , Hakan Oral  11 , Carlo Pappone  12 , Vincenzo Santinelli  12 , Rukshen Weerasooriya  13 , David J Wilber  14 , Bernard J Gersh  4 , Mark E Josephson  15 , Demosthenes G Katritsis  16
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Free article

Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation: Meta-Analysis of Quality of Life, Morbidity, and Mortality

Konstantinos C Siontis et al. JACC Clin Electrophysiol. 2016 Apr.
Free article

Abstract

Objectives: The aim of this study was to perform a collaborative meta-analysis of published and unpublished quality-of-life, morbidity, and mortality data from randomized controlled trial comparisons of radiofrequency ablation (RFA) and antiarrhythmic drug therapy (AAD) in symptomatic atrial fibrillation.

Background: RFA is superior to AAD in decreasing recurrences of atrial fibrillation, but the effects on other clinical outcomes are not well established.

Methods: The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random-effects summary estimates were calculated as standardized mean differences and risk ratios with 95% confidence intervals for continuous and binary outcomes, respectively. Fixed effects were used in subgroup analyses.

Results: Twelve randomized controlled trials (n = 1,707 patients) were included. RFA led to greater improvements in 4 36-Item Short Form Health Survey areas and the symptom frequency score from baseline to 3 months. In all quality-of-life metrics, there was a trend toward diminution of the differences between the 2 approaches with follow-up. There were 7 of 866 (5 in a study using phased RFA) and 0 of 704 strokes in the RFA and AAD arms, respectively (p = 0.02, Fisher exact test). Bleeding and mortality events were not significantly different between the 2 arms. There was high heterogeneity for hospitalizations, with decreased hospitalization risk with RFA when it was not first-line therapy (risk ratio: 0.34; 95% confidence interval: 0.24 to 0.46) and increased risk as first-line therapy (risk ratio: 1.22; 95% confidence interval: 1.03 to 1.45).

Conclusions: RFA demonstrates an early but nonsustained superiority over AAD for the improvement of quality of life. There are no obvious differences in other clinical outcomes, and the periprocedural stroke risk is non-negligible.

Keywords: antiarrhythmic drug therapy; atrial fibrillation; meta-analysis; radiofrequency ablation.

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