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Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation: Meta-Analysis of Safety and efficacy1.
Journal of Cardiovascular Pharmacology 2019 January 26
BACKGROUND: Radiofrequency ablation (RFA) and antiarrhythmic drugs (AAD) are the main treatments used for atrial fibrillation (AF). In recent years, a number of articles comparing the two treatments have begun to emerge. Though, the influence of follow-up time in the meta-analysis was not considered in these articles. However, more recently, large-scale clinical trial articles have included follow-up with the patients up to five years after treatment. Therefore, the aim of this study was to assess the impact of variable follow-up times on the recurrence of AF by observing both the short-term and long-term efficacy and safety of catheter ablation and antiarrhythmic drugs for the treatment of AF.
METHODS AND RESULTS: The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random effect summary estimates were calculated as standardized mean differences and odds ratios with 95% confidence intervals for continuous and binary outcomes. In this study, nine randomized controlled trials (n=1542 patients) were included. The rate of recurrence of AF with no limit on follow-up time, >12 months, >18 months, >24 months, >30 months, and approximately 36 months were compared.Furthermore, the gap between the RFA and AAD groups in the recurrence rate of AF was found to decrease inversely to follow-up time. When the follow-up time reached 24 months, the difference between RFA and AAD was relatively stable with an odds ratio of 0.45 (95% CI: 0.32 to 0.62). Overall, RFA decreased adverse events in the remaining trials, however AAD performed better in terms of safety and had fewer adverse events with RFA usually causing more serious complications.
CONCLUSION: Radiofrequency ablation is more advantageous in terms of recurrence rate of atrial fibrillation than drug therapy. In addition, the analysis suggests that this effect persists during long-term follow-up, however these benefits appear to decrease with longer follow-up time. Finally, AAD performed better in terms of safety and had fewer adverse events.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
METHODS AND RESULTS: The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random effect summary estimates were calculated as standardized mean differences and odds ratios with 95% confidence intervals for continuous and binary outcomes. In this study, nine randomized controlled trials (n=1542 patients) were included. The rate of recurrence of AF with no limit on follow-up time, >12 months, >18 months, >24 months, >30 months, and approximately 36 months were compared.Furthermore, the gap between the RFA and AAD groups in the recurrence rate of AF was found to decrease inversely to follow-up time. When the follow-up time reached 24 months, the difference between RFA and AAD was relatively stable with an odds ratio of 0.45 (95% CI: 0.32 to 0.62). Overall, RFA decreased adverse events in the remaining trials, however AAD performed better in terms of safety and had fewer adverse events with RFA usually causing more serious complications.
CONCLUSION: Radiofrequency ablation is more advantageous in terms of recurrence rate of atrial fibrillation than drug therapy. In addition, the analysis suggests that this effect persists during long-term follow-up, however these benefits appear to decrease with longer follow-up time. Finally, AAD performed better in terms of safety and had fewer adverse events.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
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