Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials
dc.contributor.author | Kewcharoen, Jakrin | |
dc.contributor.author | Prasitlumkum, Narut | |
dc.contributor.author | Chokesuwattanaskul, Ronpichai | |
dc.contributor.author | Yi, Ruiyang | |
dc.contributor.author | Jongnarangsin, Krit | |
dc.contributor.author | Bunch, Thomas J. | |
dc.contributor.author | Ranjan, Ravi | |
dc.contributor.author | Navaravong, Leenhapong | |
dc.date.accessioned | 2022-01-06T15:48:09Z | |
dc.date.available | 2023-01-06 10:48:08 | en |
dc.date.available | 2022-01-06T15:48:09Z | |
dc.date.issued | 2021-12 | |
dc.identifier.citation | Kewcharoen, Jakrin; Prasitlumkum, Narut; Chokesuwattanaskul, Ronpichai; Yi, Ruiyang; Jongnarangsin, Krit; Bunch, Thomas J.; Ranjan, Ravi; Navaravong, Leenhapong (2021). "Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials." Journal of Arrhythmia (6): 1448-1458. | |
dc.identifier.issn | 1880-4276 | |
dc.identifier.issn | 1883-2148 | |
dc.identifier.uri | https://hdl.handle.net/2027.42/171132 | |
dc.description.abstract | BackgroundRecent randomized controlled trials (RCTs) suggest that ablation is superior to antiarrhythmic drugs (AADs) as an initial therapy for paroxysmal atrial fibrillation (pAF) to prevent arrhythmia recurrences. We performed an updated meta‐analysis of RCTs, to include recent data from cryoballoon‐based ablation and to compare arrhythmia‐free survival and adverse events between ablation and AADs.MethodsWe searched MEDLINE and EMBASE from inception to December 2020. We included RCT comparing patients with pAF undergoing ablation or receiving AADs as an initial therapy. We combined data using the random‐effects model to calculate hazards ratio (HR) for arrhythmia‐free survival and odds ratio (OR) for adverse events.ResultsFive studies from 2005 to 2020 involving 985 patients were included (495 patients and 490 patients underwent ablation and medication as initial therapy, respectively). Patients who underwent ablation had higher freedom from atrial tachyarrhythmias (ATs) during the 12‐24 months follow‐up period (pooled HR = 0.48, 95% CI: 0.40‐0.59, P < .001). In a subgroup analysis of ablation method used, both cryoablation group (pooled HR = 0.49, 95% CI: 0.38‐0.64, P < .001) and radiofrequency ablation group (pooled HR = 0.47, 95%CI: 0.35‐0.64, P < .001) showed reduction in AT recurrence compared with AAD group. There were no differences in adverse events including cerebrovascular accident, pericardial effusion or tamponade, pulmonary vein stenosis, acute coronary syndrome, deep vein thrombosis and pulmonary embolism, and bradycardia requiring a pacemaker.ConclusionCatheter ablation (both cryoablation and radiofrequency ablation) is superior to AAD as an initial therapy for pAF in efficacy for reducing AT recurrences without a compromise in adverse events.We performed meta‐analysis of the most recent randomized control trials evaluating atrial fibrillation ablation as the first line therapy | |
dc.publisher | Wiley Periodicals, Inc. | |
dc.subject.other | atrial fibrillation ablation | |
dc.subject.other | first‐line therapy | |
dc.subject.other | paroxysmal atrial fibrillation | |
dc.title | Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials | |
dc.type | Article | |
dc.rights.robots | IndexNoFollow | |
dc.subject.hlbsecondlevel | Cardiovascular Medicine | |
dc.subject.hlbtoplevel | Health Sciences | |
dc.description.peerreviewed | Peer Reviewed | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/171132/1/joa312641_am.pdf | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/171132/2/joa312641.pdf | |
dc.identifier.doi | 10.1002/joa3.12641 | |
dc.identifier.source | Journal of Arrhythmia | |
dc.identifier.citedreference | Hakalahti A, Biancari F, Nielsen JC, Raatikainen MJ. Radiofrequency ablation vs. antiarrhythmic drug therapy as first line treatment of symptomatic atrial fibrillation: systematic review and meta‐analysis. Europace. 2015; 17 ( 3 ): 370 – 8. | |
dc.identifier.citedreference | Andrade J, Khairy P, Dobrev D, Nattel S. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ Res. 2014; 114 ( 9 ): 1453 – 68. | |
dc.identifier.citedreference | Simantirakis EN, Papakonstantinou PE, Kanoupakis E, Chlouverakis GI, Tzeis S, Vardas PE, et al. Recurrence rate of atrial fibrillation after the first clinical episode: a prospective evaluation using continuous cardiac rhythm monitoring. Clin Cardiol. 2018; 41 ( 5 ): 594 – 600. | |
dc.identifier.citedreference | Dorian P, Paquette M, Newman D, Green M, Connolly SJ, Talajic M, et al. Quality of life improves with treatment in the Canadian trial of atrial fibrillation. Am Heart J. 2002; 143 ( 6 ): 984 – 90. | |
dc.identifier.citedreference | Mark DB, Anstrom KJ, Sheng S, Piccini JP, Baloch KN, Monahan KH, et al. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019; 321 ( 13 ): 1275 – 85. | |
dc.identifier.citedreference | January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014; 130 ( 23 ): 2071 – 104. | |
dc.identifier.citedreference | Ghia KK, Chugh A, Good E, Pelosi F, Jongnarangsin K, Bogun F, et al. A nationwide survey on the prevalence of atrioesophageal fistula after left atrial radiofrequency catheter ablation. J Interv Card Electrophysiol. 2009; 24 ( 1 ): 33 – 6. | |
dc.identifier.citedreference | Garg L, Garg J, Gupta N, Shah N, Krishnamoorthy P, Palaniswamy C, et al. Gastrointestinal complications associated with catheter ablation for atrial fibrillation. Int J Cardiol. 2016; 224: 424 – 30. | |
dc.identifier.citedreference | Wilber DJ, Pappone C, Neuzil P, De Paola A, Marchlinski F, Natale A, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010; 303 ( 4 ): 333 – 40. | |
dc.identifier.citedreference | Packer DL, Kowal RC, Wheelan KR, Irwin JM, Champagne J, Guerra PG, et al. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol. 2013; 61 ( 16 ): 1713 – 23. | |
dc.identifier.citedreference | Morillo CA, Verma A, Connolly SJ, Kuck KH, Nair GM, Champagne J, et al. Radiofrequency ablation vs antiarrhythmic drugs as first‐line treatment of paroxysmal atrial fibrillation (RAAFT‐2): a randomized trial. JAMA. 2014; 311 ( 7 ): 692 – 700. | |
dc.identifier.citedreference | Cosedis Nielsen J, Johannessen A, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med. 2012; 367 ( 17 ): 1587 – 95. | |
dc.identifier.citedreference | Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, Saliba W, et al. Radiofrequency ablation vs antiarrhythmic drugs as first‐line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA. 2005; 293 ( 21 ): 2634 – 40. | |
dc.identifier.citedreference | Andrade JG, Wells GA, Deyell MW, Bennett M, Essebag V, Champagne J, et al. Cryoablation or drug therapy for initial treatment of atrial fibrillation. N Engl J Med. 2020. Available from: https://doi.org/10.1056/NEJMoa2029980 | |
dc.identifier.citedreference | Wazni OM, Dandamudi G, Sood N, Hoyt R, Tyler J, Durrani S, et al. Cryoballoon ablation as initial therapy for atrial fibrillation. N Engl J Med. 2020. Available from: https://doi.org/10.1056/NEJMoa2029554 | |
dc.identifier.citedreference | Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time‐to‐event data into meta‐analysis. Trials. 2007; 8: 16. | |
dc.identifier.citedreference | Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011; 343: d5928. | |
dc.identifier.citedreference | DerSimonian R, Laird N. Meta‐analysis in clinical trials. Control Clin Trials. 1986; 7 ( 3 ): 177 – 88. | |
dc.identifier.citedreference | Sterne JA, Egger M. Funnel plots for detecting bias in meta‐analysis: guidelines on choice of axis. J Clin Epidemiol. 2001; 54 ( 10 ): 1046 – 55. | |
dc.identifier.citedreference | Simmonds M. Quantifying the risk of error when interpreting funnel plots. Syst Rev. 2015; 4: 24. | |
dc.identifier.citedreference | Debray TPA, Moons KGM, Riley RD. Detecting small‐study effects and funnel plot asymmetry in meta‐analysis of survival data: a comparison of new and existing tests. Res Synth Methods. 2018; 9 ( 1 ): 41 – 50. | |
dc.identifier.citedreference | Kuck K‐H, Brugada J, Fürnkranz A, Metzner A, Ouyang F, Chun KRJ, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016; 374 ( 23 ): 2235 – 45. | |
dc.working.doi | NO | en |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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