Konstantinos C Siontis1, John P A Ioannidis2, George D Katritsis3, Peter A Noseworthy4, Douglas L Packer4, John D Hummel5, Pierre Jais6, Rungroj Krittayaphong7, Llius Mont8, Carlos A Morillo9, Jens Cosedis Nielsen10, Hakan Oral11, Carlo Pappone12, Vincenzo Santinelli12, Rukshen Weerasooriya13, David J Wilber14, Bernard J Gersh4, Mark E Josephson15, Demosthenes G Katritsis16. 1. Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. 2. Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA; Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford, California, USA. 3. Oxford University Clinical Academic Graduate School, Radcliffe Hospital, Oxford, United Kingdom. 4. Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. 5. Division of Cardiology, Ohio State University Wexner Medical Center, Ohio State University, Columbus, Ohio, USA. 6. Hôpital Cardiologique du Haut-L'évêque, l'Université Victor Segalen Bordeaux II, Institut LYRIC, Bordeaux, France. 7. Division of Cardiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 8. Thorax Institute (ICT), Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain. 9. Cardiology Division, Department of Medicine, Arrhythmia Service, Hamilton Health Sciences, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada. 10. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. 11. Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan. 12. Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy. 13. University of Western Australia, Crawley, Australia. 14. Division of Cardiology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois. 15. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. 16. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: dkatrits@bidmc.harvard.edu.
Abstract
OBJECTIVES: The aim of this study was to perform a collaborative meta-analysis of published and unpublished quality-of-life, morbidity, and mortality data from randomized controlled trial comparisons of radiofrequency ablation (RFA) and antiarrhythmic drug therapy (AAD) in symptomatic atrial fibrillation. BACKGROUND: RFA is superior to AAD in decreasing recurrences of atrial fibrillation, but the effects on other clinical outcomes are not well established. METHODS: The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random-effects summary estimates were calculated as standardized mean differences and risk ratios with 95% confidence intervals for continuous and binary outcomes, respectively. Fixed effects were used in subgroup analyses. RESULTS: Twelve randomized controlled trials (n = 1,707 patients) were included. RFA led to greater improvements in 4 36-Item Short Form Health Survey areas and the symptom frequency score from baseline to 3 months. In all quality-of-life metrics, there was a trend toward diminution of the differences between the 2 approaches with follow-up. There were 7 of 866 (5 in a study using phased RFA) and 0 of 704 strokes in the RFA and AAD arms, respectively (p = 0.02, Fisher exact test). Bleeding and mortality events were not significantly different between the 2 arms. There was high heterogeneity for hospitalizations, with decreased hospitalization risk with RFA when it was not first-line therapy (risk ratio: 0.34; 95% confidence interval: 0.24 to 0.46) and increased risk as first-line therapy (risk ratio: 1.22; 95% confidence interval: 1.03 to 1.45). CONCLUSIONS: RFA demonstrates an early but nonsustained superiority over AAD for the improvement of quality of life. There are no obvious differences in other clinical outcomes, and the periprocedural stroke risk is non-negligible.
OBJECTIVES: The aim of this study was to perform a collaborative meta-analysis of published and unpublished quality-of-life, morbidity, and mortality data from randomized controlled trial comparisons of radiofrequency ablation (RFA) and antiarrhythmic drug therapy (AAD) in symptomatic atrial fibrillation. BACKGROUND: RFA is superior to AAD in decreasing recurrences of atrial fibrillation, but the effects on other clinical outcomes are not well established. METHODS: The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random-effects summary estimates were calculated as standardized mean differences and risk ratios with 95% confidence intervals for continuous and binary outcomes, respectively. Fixed effects were used in subgroup analyses. RESULTS: Twelve randomized controlled trials (n = 1,707 patients) were included. RFA led to greater improvements in 4 36-Item Short Form Health Survey areas and the symptom frequency score from baseline to 3 months. In all quality-of-life metrics, there was a trend toward diminution of the differences between the 2 approaches with follow-up. There were 7 of 866 (5 in a study using phased RFA) and 0 of 704 strokes in the RFA and AAD arms, respectively (p = 0.02, Fisher exact test). Bleeding and mortality events were not significantly different between the 2 arms. There was high heterogeneity for hospitalizations, with decreased hospitalization risk with RFA when it was not first-line therapy (risk ratio: 0.34; 95% confidence interval: 0.24 to 0.46) and increased risk as first-line therapy (risk ratio: 1.22; 95% confidence interval: 1.03 to 1.45). CONCLUSIONS: RFA demonstrates an early but nonsustained superiority over AAD for the improvement of quality of life. There are no obvious differences in other clinical outcomes, and the periprocedural stroke risk is non-negligible.
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Heart Rhythm Date: 2017-05-12 Impact factor: 6.343
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; José Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: Heart Rhythm Date: 2012-03-01 Impact factor: 6.343
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Europace Date: 2018-01-01 Impact factor: 5.214
Authors: Katherine S Allan; Theresa Aves; Shaunattonie Henry; Laura Banfield; J Charles Victor; Paul Dorian; Jeff S Healey; Jason G Andrade; Sandra L Carroll; Michael H McGillion Journal: CJC Open Date: 2020-04-02
Authors: Thomas J Buist; Ahmet Adiyaman; Rypko J Beukema; Jaap Jan J Smit; Peter Paul H M Delnoy; Martin E W Hemels; Hauw T Sie; Anand R Ramdat Misier; Arif Elvan Journal: Clin Res Cardiol Date: 2019-06-24 Impact factor: 5.460