Shaojie Chen1,2, Helmut Pürerfellner3, Feifan Ouyang4, Márcio Galindo Kiuchi5, Christian Meyer6,7,8,9, Martin Martinek3, Piotr Futyma10, Lin Zhu11, Alexandra Schratter12, Jiazhi Wang13, Willem-Jan Acou14, Zhiyu Ling15, Yuehui Yin15, Shaowen Liu16, Philipp Sommer17, Boris Schmidt1, Julian K R Chun1,2. 1. Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany. 2. Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany. 3. Department für Kardiologie und Elektrophysiologie, Akademisches Lehrkrankenhaus, Ordensklinikum Linz Elisabethinen, Linz, Austria. 4. Klinik und Poliklinik für Kardiologie, Universitäres Herz und Gefäßzentrum, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany. 5. School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Perth, Australia. 6. Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 7. DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. 8. Department of Cardiology, Evangelical Hospital Düsseldorf, Düsseldorf, Germany. 9. Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany. 10. St. Joseph's Heart Rhythm Center, Rzeszów, Poland. 11. Medizinisch-Geriatrische Klinik, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany. 12. Medizinische Abteilung mit Kardiologie, Krankenhaus Hietzing Wien, Vienna, Austria. 13. Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany. 14. Department of Cardiology, AZ Delta, Roeselare, Belgium. 15. Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. 16. Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 17. Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Abstract
AIMS: Catheter ablation (CA) is recommended for patients with atrial fibrillation (AF) after failure of antiarrhythmic drugs (AADs). The role of CA as 'initial therapy' for AF is to be determined. METHODS AND RESULTS: Following PRISMA guideline an up-to-date pooled analysis of randomized data comparing ablation vs. AADs as first-line therapy for symptomatic AF was performed. The primary outcome was recurrence of atrial tachyarrhythmia. The secondary outcomes were improvement in quality-of-life (QoL) and major adverse events. A total of 997 patients from five randomized trials were enrolled (mean age 57.4 years, 68.6% male patients, 98% paroxysmal AF, mean follow-up 1.4 years). The baseline characteristics were similar between the ablation and AADs group. Overall pooled analysis showed that, as compared with AADs, CA as first-line therapy was associated with significantly higher freedom from arrhythmia recurrence (69% vs. 48%, odds ratio: 0.36, 95% confidence interval: 0.27-0.48, P < 0.001). This significance was maintained in subgroup analyses of 1- and 2-year follow-up (P < 0.001). Catheter ablation was associated with significantly greater improvement in QoL regarding AFEQT score and 36-Item Short-Form Health Survey score. The incidence of serious adverse events between ablation and AADs group (5.6% vs. 4.9%, P = 0.62) was similar. CONCLUSIONS: Catheter ablation as 'initial therapy' was superior to AADs in maintenance of sinus rhythm and improving QoL for patients with symptomatic paroxysmal AF, without increasing risk of serious adverse events. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Catheter ablation (CA) is recommended for patients with atrial fibrillation (AF) after failure of antiarrhythmic drugs (AADs). The role of CA as 'initial therapy' for AF is to be determined. METHODS AND RESULTS: Following PRISMA guideline an up-to-date pooled analysis of randomized data comparing ablation vs. AADs as first-line therapy for symptomatic AF was performed. The primary outcome was recurrence of atrial tachyarrhythmia. The secondary outcomes were improvement in quality-of-life (QoL) and major adverse events. A total of 997 patients from five randomized trials were enrolled (mean age 57.4 years, 68.6% male patients, 98% paroxysmal AF, mean follow-up 1.4 years). The baseline characteristics were similar between the ablation and AADs group. Overall pooled analysis showed that, as compared with AADs, CA as first-line therapy was associated with significantly higher freedom from arrhythmia recurrence (69% vs. 48%, odds ratio: 0.36, 95% confidence interval: 0.27-0.48, P < 0.001). This significance was maintained in subgroup analyses of 1- and 2-year follow-up (P < 0.001). Catheter ablation was associated with significantly greater improvement in QoL regarding AFEQT score and 36-Item Short-Form Health Survey score. The incidence of serious adverse events between ablation and AADs group (5.6% vs. 4.9%, P = 0.62) was similar. CONCLUSIONS: Catheter ablation as 'initial therapy' was superior to AADs in maintenance of sinus rhythm and improving QoL for patients with symptomatic paroxysmal AF, without increasing risk of serious adverse events. Published on behalf of the European Society of Cardiology. All rights reserved.