Zia Khan Muhammad1, Khan Safi U1, Arshad Adeel2, Samsoor Zarak Muhammad3, Khan Muhammad U1, Shahzeb Khan Muhammad4, Kaluski Edo5, Alkhouli Mohamad6. 1. Department of Medicine, West Virginia University, Morgantown, WV, USA. 2. Rochester Regional Health/Unity Hospital, Rochester, NY. 3. Department of Cardiovascular Medicine, West Virginia University, Morgantown, WV, USA. 4. Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA. 5. Department of Medicine, Guthrie/Robert Packer Hospital, Sayre, PA, USA. 6. Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN.
Abstract
INTRODUCTION: Catheter ablation has shown to reduce mortality in patient with atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction. Its effect on mortality in patients without HF has not been well elucidated. METHODS: Thirteen randomized controlled trials encompassing 3856 patients were selected using PubMed, Embase and the CENTRAL till April 2019. Estimates were reported as random effects risk ratio (RR) with 95% confidence intervals (CI). RESULTS: Compared with medical therapy, catheter ablation did not reduce the risk of all-cause mortality (RR, 0.86, 95% CI, 0.62-1.19, P=0.36; I2=0), stroke (RR, 0.55, 95% CI, 0.18-1.66, P=0.29; I2=0), need for cardioversion (RR, 0.84, 95% CI, 0.66-1.08, P=0.17; I2=0) or pacemaker (RR, 0.59, 95% CI, 0.34-1.01, P=0.06; I2=0). However, ablation reduced the RR of cardiac hospitalization (0.37, 95% CI, 0.18-0.77, P=0.01; I2=86), and recurrent atrial arrhythmia (0.46, 95% CI, 0.35-0.60, P<0.001; I2=87). There were non-significant differences among treatment groups with respect to major bleeding (RR, 1.89, 95% CI, 0.59-6.08, P=0.29; I2=15), and pulmonary vein stenosis (RR, 3.00, 95% CI, 0.83-10.87, P=0.09; I2=0), but had significantly higher rates of pericardial tamponade (RR, 4.46, 95 % CI, 1.70-11.72, P<0.001; I2=0). CONCLUSIONS: Catheter ablation did not improve survival compared with medical therapy in patients with AF without HF. Catheter ablation reduced cardiac hospitalization and recurrent atrial arrhythmia at the expense of pericardial tamponade.
INTRODUCTION: Catheter ablation has shown to reduce mortality in patient with atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction. Its effect on mortality in patients without HF has not been well elucidated. METHODS: Thirteen randomized controlled trials encompassing 3856 patients were selected using PubMed, Embase and the CENTRAL till April 2019. Estimates were reported as random effects risk ratio (RR) with 95% confidence intervals (CI). RESULTS: Compared with medical therapy, catheter ablation did not reduce the risk of all-cause mortality (RR, 0.86, 95% CI, 0.62-1.19, P=0.36; I2=0), stroke (RR, 0.55, 95% CI, 0.18-1.66, P=0.29; I2=0), need for cardioversion (RR, 0.84, 95% CI, 0.66-1.08, P=0.17; I2=0) or pacemaker (RR, 0.59, 95% CI, 0.34-1.01, P=0.06; I2=0). However, ablation reduced the RR of cardiac hospitalization (0.37, 95% CI, 0.18-0.77, P=0.01; I2=86), and recurrent atrial arrhythmia (0.46, 95% CI, 0.35-0.60, P<0.001; I2=87). There were non-significant differences among treatment groups with respect to major bleeding (RR, 1.89, 95% CI, 0.59-6.08, P=0.29; I2=15), and pulmonary vein stenosis (RR, 3.00, 95% CI, 0.83-10.87, P=0.09; I2=0), but had significantly higher rates of pericardial tamponade (RR, 4.46, 95 % CI, 1.70-11.72, P<0.001; I2=0). CONCLUSIONS: Catheter ablation did not improve survival compared with medical therapy in patients with AF without HF. Catheter ablation reduced cardiac hospitalization and recurrent atrial arrhythmia at the expense of pericardial tamponade.
Entities:
Keywords:
Atrial fibrillation; Catheter ablation; Medical therapy; Meta-analysis
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