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Meta-Analysis
. 2022 Jul;119(1):87-94.
doi: 10.36660/abc.20210477.

Catheter Ablation is Superior to Antiarrhythmic Drugs as First-Line Treatment for Atrial Fibrillation: a Systematic Review and Meta-Analysis

[Article in English, Portuguese]
Rhanderson Cardoso  1 , Gustavo B Justino  2 , Fabrissio P Graffunder  2 , Leticia Benevides  3 , Leonardo Knijnik  4 , Luana M F Sanchez  5 , Andre d'Avila  6   7
Affiliations
Meta-Analysis

Catheter Ablation is Superior to Antiarrhythmic Drugs as First-Line Treatment for Atrial Fibrillation: a Systematic Review and Meta-Analysis

[Article in English, Portuguese]
Rhanderson Cardoso et al. Arq Bras Cardiol. 2022 Jul.

Abstract
in English, Portuguese

Background: Catheter ablation is a well-established therapy for rhythm control in patients who are refractory or intolerant to anti-arrhythmic drugs (AAD). Less is known about the efficacy of catheter ablation compared with AAD as a first-line strategy for rhythm control in atrial fibrillation (AF).

Objectives: We aimed to perform a systematic review and meta-analysis of catheter ablation vs. AAD in patients naïve to prior rhythm control therapies.

Methods: PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials that compared catheter ablation to AAD for initial rhythm control in symptomatic AF and reported the outcomes of (1) recurrent atrial tachyarrhythmias (ATs); (2) symptomatic AF; (3) hospitalizations; and (4) symptomatic bradycardia. Heterogeneity was examined with I2statistics. P values of < 0.05 were considered statistically significant.

Results: We included five trials with 994 patients, of whom 502 (50.5%) underwent catheter ablation. Mean follow-up ranged from one to five years. Recurrences of AT (OR 0.36; 95% CI 0.25-0.52; p<0.001) and symptomatic AF (OR 0.32; 95% CI 0.18-0.57; p<0.001), and hospitalizations (OR 0.25; 95% CI 0.15-0.42; p<0.001) were significantly less frequent in patients treated with catheter ablation compared with AAD. Symptomatic bradycardia was not significantly different between groups (OR 0.55; 95% CI 0.18-1.65; p=0.28). Significant pericardial effusions or tamponade occurred in eight of 464 (1.7%) patients in the catheter ablation group.

Conclusion: These findings suggest that catheter ablation has superior efficacy to AAD as an initial rhythm control strategy in patients with symptomatic AF.

Fundamento: A ablação por cateter é uma terapia bem estabelecida para controle do ritmo cardíaco em pacientes refratários ou intolerantes a drogas antiarrítmicas (DAA). Porém, a eficácia desse procedimento comparada à de DAA como estratégia de primeira linha no controle do ritmo cardíaco na fibrilação atrial é menos conhecida.

Objetivos: Conduzir uma revisão sistemática e metanálise da ablação por cateter vs. DAA em pacientes sem nenhum tratamento prévio para controle do ritmo.

Métodos: Buscamos, nos bancos de dados do PubMed, EMBASE, e Cochrane, ensaios randomizados controlados que compararam ablação por cateter com DAA para controle do ritmo cardíaco em pacientes com FA sintomática e descreveram os seguintes desfechos: (1) recorrência de taquiarritmia atrial (TA); (2) FA sintomática; (3) internações hospitalares; e (4) bradicardia sintomática. A heterogeneidade foi avaliada por estatística I2. Valores de p menores que 0,05 foram considerados estatisticamente significativos.

Resultados: Incluímos cinco ensaios com 994 pacientes, dos quais 502 (50,5%) foram submetidos à ablação por cateter. O período médio de acompanhamento foi de um a cinco anos. Recorrências de TA (OR 0,36; IC95% 0,25-0,52; p<0,001) e de FA sintomática (OR 0,32; IC95% 0,18-0,57; p<0,001), e internações hospitalares (OR 0,25; IC95% 0,15-0,42; p<0,001) foram menos frequentes nos pacientes tratados com ablação por cateter que naqueles tratados com DAA. Bradicardia sintomática não foi diferente entre os grupos (OR 0,55; IC95% 0,18-1,65; p=0,28). Derrame ou tamponamento pericárdico significativo ocorreu em oito dos 464 (1,7%) pacientes no grupo submetido à ablação.

Conclusão: Esses achados sugerem maior eficácia da ablação por cateter que das DAA como estratégia inicial de controle do ritmo cardíaco em pacientes com DA sintomática.

PubMed Disclaimer

Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

Figura 1
Figura 1. – Fluxograma PRISMA da triagem e seleção dos estudos
Figura 2
Figura 2. – Recorrências de taquiarritmia atrial foram significativamente menos comum com ablação por cateter que com terapia com drogas antiarrítmicas (p<0,001). DAA: drogas antiarrítmicas.
Figura 3
Figura 3. – Recorrências de fibrilação atrial sintomática foram significativamente menos comum com ablação por cateter que com terapia com drogas antiarrítmicas (p<0,001). DAA: drogas antiarrítmicas.
Figura 4
Figura 4. – Internações hospitalares foram significativamente menos comum com ablação por cateter que com terapia com DAA (p<0,001). DAA: drogas antiarrítmicas.
Figura 5
Figura 5. – Incidência de bradicardia sintomática foi rara e similar entre os grupos (p=0,28). DAA: drogas antiarrítmicas.
Figure 1
Figure 1. – PRISMA flow diagram of study screening and selection
Figure 2
Figure 2. – Recurrences of atrial tachyarrhythmias were significantly less common with catheter ablation compared to antiarrhythmic drugs (p<0.001). AAD: antiarrhythmic drugs.
Figure 3
Figure 3. – Recurrences of symptomatic AF were significantly less common with catheter ablation compared to antiarrhythmic drugs. (p<0.001). AAD: antiarrhythmic drugs.
Figure 4
Figure 4. – Hospitalizations were significantly less common with catheter ablation compared to antiarrhythmic drugs (p<0.001). AAD: antiarrhythmic drugs.
Figure 5
Figure 5. – The incidence of symptomatic bradycardia was rare and similar between groups (p=0.28). AAD: antiarrhythmic drugs.
See this image and copyright information in PMC

Comment in

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