Author + information
- Received February 2, 2018
- Revision received February 23, 2018
- Accepted March 1, 2018
- Published online May 21, 2018.
- aDepartment of Medicine, Guthrie Health System/Robert Packer Hospital, Sayre, Pennsylvania
- bRutgers New Jersey Medical School, Newark, New Jersey
- cThe Commonwealth Medical College, Scranton, Pennsylvania
- ↵∗Address for correspondence:
Dr. Safi U. Khan, Department of Medicine, Robert Packer Hospital, 1 Guthrie Square, Sayre, Pennsylvania 18840.
Objectives This study sought to compare the efficacy and safety of catheter ablation (CA) with those of medical therapy (MT) for the treatment of atrial fibrillation (AF).
Background The preferred therapeutic strategy for subjects with AF remains unclear.
Methods A total of 17 randomized controlled trials were selected using Medline, EMBASE, and CENTRAL (September 1998 to 2 February 2018). The analysis was stratified at the trial level according to the following: 1) patients with AF and heart failure (HF); and 2) patients with AF without HF.
Results A total of 2,272 patients with AF (775 patients with HF and 1,497 patients without HF) participated in this analysis. In patients with HF, CA was associated with significant relative risk reduction in all-cause mortality (risk ratio [RR]: 0.52; 95% confidence interval [CI]: 0.36 to 0.76; p < 0.001; I2 = 0), recurrent atrial arrhythmia (RR: 0.44; 95% CI: 0.31 to 0.61; p <0.001; I2 = 56), and cardiac hospitalization (RR: 0.63; 95% CI: 0.46 to 0.87; p = 0.01; I2 = 43) compared with MT. Conversely, in patients without HF, CA had no beneficial effect on the risk of all-cause mortality compared with MT (RR: 0.88, 95% CI: 0.29 to 2.61; p = 0.81; I2 = 0). However, CA reduced the risk of recurrent atrial arrhythmia (RR: 0.40; 95% CI: 0.31 to 0.52; p < 0.001; I2 = 73) and cardiac hospitalization (RR: 0.32; 95% CI: 0.23 to 0.45; p < 0.001; I2 = 0) in patients without HF.
Conclusions This meta-analysis suggests that although CA reduced the risk of cardiac hospitalization and recurrent atrial arrhythmia both in subjects with HF and in subjects without HF, the reduction in all-cause mortality was limited to subjects with HF only.
This project has received funding from Guthrie Health System research department. Dr. Kaluski is a consultant to and speaker for Janssen, Pfizer, Bristol-Myers Squibb, and Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 2, 2018.
- Revision received February 23, 2018.
- Accepted March 1, 2018.
- 2018 American College of Cardiology Foundation