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Meta-Analysis
. 2023 Oct;46(10):1146-1153.
doi: 10.1002/clc.24092. Epub 2023 Jul 20.

Short-term and long-term effects of cryoballoon ablation versus antiarrhythmic drug therapy as first-line treatment for paroxysmal atrial fibrillation: A systematic review and meta-analysis

Zirui Liu  1 , Zhengkai Yang  1 , Yu Lu  1 , Haocheng Wang  1 , Cao Zou  1
Affiliations
Meta-Analysis

Short-term and long-term effects of cryoballoon ablation versus antiarrhythmic drug therapy as first-line treatment for paroxysmal atrial fibrillation: A systematic review and meta-analysis

Zirui Liu et al. Clin Cardiol. 2023 Oct.

Abstract

Cryoballoon ablation (CBA) is an effective treatment for drug-refractory atrial fibrillation (AF) patients. Whether CBA as a first-line treatment is superior in the rhythm control of AF than antiarrhythmic drugs (AAD) remains unclear. CBA is superior to AAD as initial therapy for rhythm control of paroxysmal atrial fibrillation (PAF). A comprehensive database search was performed in PubMed, Embase, Cochrane, and Web of Science from inception to March 22, 2023. Treatment efficacy was pooled using risk ratio (RR) and standardized mean difference (SMD) with a 95% confidence interval (CI). This study was registered with Prospero (CRD42023401596). Five randomized-controlled trials involving 923 patients and an observational study were included in this study. The CBA group had a significantly lower overall recurrence rate than the AAD group (CBA vs. AAD: RR = 0.59, 95% CI = 0.49-0.71, p < .05, I2 = 0). The incidence of persistent AF could be better controlled in the CBA group than in the AAD (CBA vs. AAD: RR = 0.17, 95% CI = 0.06-0.49, p < .05, I2 = 0). CBA could improve the quality of life (QoL) of patients better than AAD (CBA vs. AAD: SMD = 0.40, 95% CI = 0.14-0.67, p < .05, I2 = 68.5%). CBA can reduce hospitalization rate significantly than AAD at 36-month follow-up (CBA vs. AAD: RR = 0.29, 95% CI = 0.15-0.58, p < .05, I2 = 0%). Compared to AAD, CBA as first-line therapy could reduce the recurrence rate of atrial arrhythmia and incidence of persistent AF and improve QoL in PAF patients with lower incidences of hospitalization.

Keywords: antiarrhythmic drugs; atrial fibrillation; cryoballoon ablation; first-line treatment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analysis diagram of study selection process.
Figure 2
Figure 2
Forest plot of the recurrence of atrial tachyarrhythmias at 1 year. CI, confidence interval; RR, risk ratio.
Figure 3
Figure 3
Forest plot of the incidence of persistent atrial fibrillation at 3 years. CI, confidence interval; RR, risk ratio.
Figure 4
Figure 4
Forest plot of the quality of life of paroxysmal atrial fibrillation patients at 3 years. CI, confidence interval; SMD, standardized mean difference.
Figure 5
Figure 5
Forest plot of the 3‐year cumulative hospitalization of paroxysmal atrial fibrillation patients. CI, confidence interval; RR, risk ratio.
See this image and copyright information in PMC

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