Radiofrequency Ablation vs. Drug Therapy for Atrial Fibrillation
Does radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) improve outcomes other than efficacy compared to antiarrhythmic drug therapy (AADT)?
Twelve clinical trials in which patients with paroxysmal or persistent AF were randomly assigned to RFCA or AADT were included in this meta-analysis. The outcomes of this study were quality of life, hospitalizations, strokes, bleeding events, and mortality. When possible, data missing from the original publications were supplied by the original investigators.
Several measures of quality of life improved significantly after RFCA compared to AADT at 3 months of follow-up, but the magnitude of the differences diminished over time and no longer were significant at ≥9 months of follow-up. Hospitalizations were significantly less likely after RFCA than with AADT, but only when it was not first-line therapy. The stroke rate after RFCA was low (0.3%), but significantly higher than in the AADT group. There were no significant differences in bleeding events or mortality between RFCA and AADT.
Quality of life transiently is improved to a greater degree after RFCA than with AADT. There are minimal or no differences in the risk of stroke, bleeding events, hospitalizations, or death between RFCA and AADT.
RFCA was superior to AADT for prevention of AF in all of the studies in this meta-analysis. A randomized clinical trial still in progress (CABANA) was designed to detect differences between RFCA and AADT in endpoints other than only efficacy, including stroke rate and mortality. The results of this study should be very helpful in establishing whether RFCA yields any benefits over AADT other than a reduction in AF burden.
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