AIM: RF ablation for a-fib is effective as second-line therapy out to one year

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Radiofrequency (RF) catheter ablation is effective for up to 12 months of rhythm control when used as a second-line therapy for atrial fibrillation (AF) in relatively young patients with near-intact cardiac function, according to an analysis published Aug. 4 in the Annals of Internal Medicine.

Teruhiko Terasawa, MD, from Tufts Medical Center in Boston, and colleagues sought to compare the benefits and harms of RF catheter ablation and medical therapy in adults with AF by searching MEDLINE and the Cochrane Central Register of Controlled Trials (2000 to December 2008) for English-language reports of studies in adults.

Six independent reviewers screened abstracts for longitudinal studies of adults with AF who underwent RF catheter ablation. They selected studies that reported arrhythmia or other cardiovascular outcomes at least six months after ablation or any adverse events. The data was extracted by one of four reviewers and verified by a cardiac electrophysiologist.

Investigators found 108 studies which met eligibility criteria. Moderate strength of evidence (three trials with between 30 to 198 participants) showed that RF ablation after a failed drug course was more likely than continuation of drug therapy alone to lead to maintained sinus rhythm, according to the researchers. Low strength of evidence (four trials with between 30 to 137 participants and one retrospective study with 1,171 participants) suggested that RF ablation improved quality of life, promoted avoidance of anticoagulation, and decreased readmission rates compared with medical treatment.

Terasawa and colleagues reported that major adverse events, such as pulmonary-vein stenosis or cardiac tamponade, occurred in fewer than 5 percent of patients in most of 84 studies.

Among the limitations of their study, the authors listed the following: follow-up was generally 12 months or less; large heterogeneity of applied techniques and reporting of outcomes precluded definitive conclusions; poor reporting of adverse events; publication and selective reporting biases could not be ruled out; and the exclusion of studies with small samples and studies reported in a language other than English.

The researchers concluded that their systematic review found that "RF ablation after a failed drug course maintained sinus rhythm more often than continuation of drug therapy alone. Some studies found that ablation improved quality of life, but did not necessarily reduce stroke rates compared with medical therapy."

The authors also noted that longer studies that use primary end points of stroke and mortality are needed.