When treating atrial fibrillation (AFib), catheter ablation is associated with better outcomes — including fewer hospitalizations — than antiarrhythmic drugs (AADs), according to a new meta-analysis published in Circulation: Arrhythmia and Electrophysiology.
“In patients with symptomatic paroxysmal AFib, current United States consensus guidelines recommend AADs as the initial therapy for maintenance of sinus rhythm,” wrote lead author Babikir Kheiri, MD, a cardiologist at Oregon Health & Science University, and colleagues. “However, given the substantial adverse effects of AADs and their limited efficacy in maintenance of sinus rhythm, catheter ablation is an attractive strategy.”
The team focused on data from 997 patients who participated in one of five different randomized controlled trials. All patients presented with paroxysmal AFib and had not previously been prescribed AADs.
While 68.6% of the cohort was male, the mean patient age was 57.3 years old. Also, 40.6% of patients presented with hypertension, and 6.5% presented with coronary heart disease. The mean duration of AFib was 1.3 years, and the mean ejection fraction was 59.7%. For patients undergoing an ablation, the mean procedure length was 139.1 minutes, including 29.4 minutes of fluoroscopy time.
Overall, the authors found, ablation was associated with a 43% reduction in recurrent atrial tachyarrhythmia, a 55% reduction in symptomatic recurrence and a 67% reduction in all-cause hospitalization. Rates of mortality, stroke, transient ischemic attack and serious adverse events were similar between the two treatment methods.
The full study is available here.
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