Catheter ablation of paroxysmal atrial fibrillation and disease progression: Magnitude of the antiprogression effect and role of intervention timing

Abstract

Background: Recent randomized controlled trials (RCTs) have shown that catheter ablation of paroxysmal atrial fibrillation (AF) is associated with a lower incidence of progression to persistent AF compared with the use of antiarrhythmic drug (AAD) therapy.

Objective: This meta-analysis aimed to investigate the magnitude of the antiprogression effect of catheter ablation as well as the effect of intervention timing.

Methods: MEDLINE/EMBASE databases were searched until April 1, 2024 for RCTs comparing catheter ablation and AAD therapy for the treatment of paroxysmal AF and reporting the rate of progression to persistent AF at 3 years (PROSPERO CRD42024534288).

Results: A total of 1287 references were retrieved, of which 5 RCTs met inclusion criteria. The rate of progression to persistent AF was 8.3% (95% confidence interval [CI] 5.4-11.2, I² = 67.2%) at 3 years. The 3-year rate of progression to persistent AF was significantly lower in patients randomized to catheter ablation (1.8%; 95% CI 0.3-3.3; I² = 0%) compared with AAD (14.9%; 95% CI 9.3-20.5; I² = 71.9%); representing a risk ratio of progression to persistent AF at 3 years of 0.15 (95% CI 0.08-0.28; I² = 0%; P < .001) for catheter ablation vs AAD therapy. Catheter ablation appeared similarly efficient in reducing progression of AF when used as first-line or non-first-line therapy (risk ratio [RR] = 0.19; 95% CI 0.07-0.48 and RR = 0.13, 95% CI 0.05-0.29, respectively, P_interaction = .551).

Conclusion: The risk of progression to persistent AF at 3 years appears to be reduced by almost 7-fold in patients with paroxysmal AF treated using catheter ablation compared with patients treated using AAD therapy, regardless of the timing of the intervention.

Keywords: Ablation; Antiarrhythmic drugs; Atrial fibrillation; Paroxysmal; Persistent; Progression; Transition.