Catheter ablation vs. antiarrhythmic drugs as ‘first-line’ initial therapy for atrial fibrillation: a pooled analysis of randomized data

• Published in: Europace (London, England) England), 2021-12, Vol.23 (12), p.1950-1960
• Main Authors: Chen, Shaojie, Pürerfellner, Helmut, Ouyang, Feifan, Kiuchi, Márcio Galindo, Meyer, Christian, Martinek, Martin, Futyma, Piotr, Zhu, Lin, Schratter, Alexandra, Wang, Jiazhi, Acou, Willem-Jan, Ling, Zhiyu, Yin, Yuehui, Liu, Shaowen, Sommer, Philipp, Schmidt, Boris, Chun, Julian K R
• Format: Article
• Language: English
• Subjects: Anti-Arrhythmia Agents - adverse effects; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Atrial Fibrillation - surgery; Catheter Ablation - adverse effects; Catheter Ablation - methods; Female; Humans; Male; Middle Aged; Quality of Life; Recurrence; Tachycardia - etiology; Treatment Outcome
• ISSN: 1099-5129; 1532-2092; 1532-2092
• DOI: 10.1093/europace/euab185

Abstract Aims Catheter ablation (CA) is recommended for patients with atrial fibrillation (AF) after failure of antiarrhythmic drugs (AADs). The role of CA as ‘initial therapy’ for AF is to be determined. Methods and results Following PRISMA guideline an up-to-date pooled analysis of randomized data comparing ablation vs. AADs as first-line therapy for symptomatic AF was performed. The primary outcome was recurrence of atrial tachyarrhythmia. The secondary outcomes were improvement in quality-of-life (QoL) and major adverse events. A total of 997 patients from five randomized trials were enrolled (mean age 57.4 years, 68.6% male patients, 98% paroxysmal AF, mean follow-up 1.4 years). The baseline characteristics were similar between the ablation and AADs group. Overall pooled analysis showed that, as compared with AADs, CA as first-line therapy was associated with significantly higher freedom from arrhythmia recurrence (69% vs. 48%, odds ratio: 0.36, 95% confidence interval: 0.27–0.48, P