Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The current guidelines recommend a trial of antiarrhythmic drugs (AAD) before ablation is considered. However, the concept "first do no harm" plays an integral role in the management of atrial fibrillation. Little is known about ablation as first line therapy for untreated patients with symptomatic atrial fibrillation.
Methods
Electronic databases (Medline, Scopus, Embase) were searched until 25th November 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05. Randomised controlled trials (RCTs) evaluating catheter ablation vs AAD as first line therapy were included. The primary outcome of interest was recurrence of any atrial tachyarrhythmia (symptomatic/asymptomatic, atrial fibrillation, atrial flutter and atrial tachycardia). Secondary outcomes included recurrence of symptomatic atrial tachyarrhythmia, major adverse events and cardiovascular adverse events.
Results
A total of five studies with 986 (Ablation = 496; AAD = 490) participants were included. Patients receiving ablation were less prone to experience any type of atrial tachyarrhythmia when compared to patients receiving anti-arrhythmic drugs (OR 0.42; 95%CI 0.31 to 0.55; p < 0.00001; I²=0) The incidence of symptomatic atrial tachyarrhythmia was also higher in the AAD arm (OR 0.33; 95%CI 0.18-0.62; p = 0.0006; I²=59%). There were no statistically significant differences for major(OR1.30; 95%CI0.85 to 1.98; p = 0.22; I²=0)and cardiovascular adverse events (OR 1.13; 95%CI 0.69-1.86; p = 0.64 I²=0) respectively.
Conclusion
Catheter ablation was associated with a significantly lower rate of tachyarrhythmia recurrence than conventional anti-arrhythmic drugs, but may also cause adverse events Abstract Figure.
Catheter ablation versus antiarrhythmic medication as first line therapy in paroxysmal atrial fibrillation: on treatment analysis of the MANTRA-PAF data
