Investigating the Efficiency and Tolerability of Traditional Chinese Formulas Combined with Antiarrhythmic Agents for Paroxysmal Atrial Fibrillation: A Systematic Review and Bayesian Network Meta-analysis

Objectives: The role of sotalol is well established for the maintenance of sinus rhythm after successful conversion of atrial fibrillation (AF). However, its role in pharmacologic conversion of AF is poorly defined. The purpose of this study is to compare the efficacy of sotalol to that of other antiarrhythmic agents for AF conversion. Methods: Standard methods of meta-analysis were employed. Full-text publications of clinical trials in English that compared the efficacy of sotalol to that of other antiarrhythmics or placebo/no treatment were eligible for inclusion. Results: A systematic review revealed 10 eligible publications. Sotalol was superior to placebo and/or no antiarrhythmic therapy in AF conversion, with a relative success of 24 (95% CI 4.7-119, p < 0.001). Sotalol was not significantly different from class IA antiarrhythmic drugs. Similarly, sotalol was not different from class IC antiarrhythmic drugs or amiodarone in terms of conversion efficacy. In one study, sotalol was less effective than high-dose ibutilide (2 mg), with a relative success of 0.248 (95% CI 0.128-0.481, p < 0.001). Ibutilide caused more proarrhythmia. Conclusions: Sotalol is as effective as class IA and class IC antiarrhythmic agents, and it is also as effective as amiodarone for pharmacologic conversion of AF. Only ibutilide at a high dose showed a greater conversion rate of AF.

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Leucocyte telomere length and paroxysmal atrial fibrillation: A prospective cohort study and systematic review with meta‐analysis

Journal of Clinical Laboratory Analysis ◽

10.1002/jcla.22599 ◽

2018 ◽

Vol 32 (9) ◽

Cited By ~ 4

Author(s):

Nixiao Zhang ◽

Chong Fan ◽

Mengqi Gong ◽

Xue Liang ◽

Weili Zhang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Cohort Study ◽

Telomere Length ◽

Prospective Cohort Study ◽

Paroxysmal Atrial Fibrillation ◽

Prospective Cohort ◽

Meta Analysis

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Additional complex fractionated atrial electrogram ablation does not improve the outcomes in non-paroxysmal atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials

Indian Heart Journal ◽

10.1016/j.ihj.2020.11.004 ◽

2020 ◽

Author(s):

Yoga Waranugraha ◽

Ardian Rizal ◽

Dion Setiawan ◽

Indra Jabbar Aziz

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Randomized Controlled Trials ◽

Paroxysmal Atrial Fibrillation ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Atrial Electrogram ◽

Complex Fractionated Atrial Electrogram

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Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis

Heart ◽

10.1136/heartjnl-2021-319496 ◽

2021 ◽

pp. heartjnl-2021-319496

Author(s):

Jacopo F Imberti ◽

Wern Yew Ding ◽

Agnieszka Kotalczyk ◽

Juqian Zhang ◽

Giuseppe Boriani ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Catheter Ablation ◽

Paroxysmal Atrial Fibrillation ◽

Meta Analysis ◽

Cochrane Library ◽

Atrial Arrhythmias ◽

Line Treatment ◽

First Line ◽

First Line Treatment

ObjectiveTo assess the efficacy and safety of catheter ablation (CA) compared with antiarrhythmic drugs (AADs) as first-line treatment for symptomatic paroxysmal atrial fibrillation (AF).MethodsSystematic review and meta-analysis of randomised controlled trials identified using MEDLINE, Cochrane Library and Embase published between 01/01/2000 and 19/03/2021. The primary efficacy endpoint was the first documented recurrence of atrial arrhythmias following the blanking period. The primary safety endpoint was a composite of all serious adverse events (SAEs).ResultsFrom 441 records, 6 studies met the inclusion criteria. 609 patients received CA, while 603 received AAD therapy. 212/609 patients in the CA group had a recurrence of atrial arrhythmias as compared with 318/603 in the AADs group resulting in a 36% relative risk reduction (risk ratio: 0.64, 95% CI 0.51 to 0.80, p<0.01). The risk of all SAEs was not statistically different between CA and AAD (0.87, 0.58 to 1.30, p=0.49); 107/609 SAE in the CA group vs 126/603 in the AAD group. Both recurrence of symptomatic atrial arrhythmias (109/505 vs 186/504) and healthcare utilisation (126/397 vs 185/394) were significantly lower in the CA group (0.53, 0.35 to 0.79 and 0.65, 0.48 to 0.89, respectively). There was a 79% reduction in the crossover rate during follow-up among patients randomised to CA compared with AAD (0.21, 0.13 to 0.32, p<0.01).ConclusionsFirst-line treatment with CA is superior to AAD therapy in patients with symptomatic paroxysmal AF, as it significantly reduces the recurrence of any atrial arrhythmias and symptomatic atrial arrhythmias, and healthcare resource utilisation with comparable safety profile.

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Direct Comparison Between Second-Generation Cryoballoon Ablation Versus Contact Force-Sensing Radiofrequency Ablation in Paroxysmal Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis Study

10.21203/rs.3.rs-654073/v1 ◽

2021 ◽

Author(s):

Yoga Waranugraha ◽

Ardian Rizal ◽

Yoga Yuniadi

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Paroxysmal Atrial Fibrillation ◽

Phrenic Nerve ◽

Meta Analysis ◽

Force Sensing ◽

Rf Ablation ◽

Nerve Paralysis ◽

Analysis Study ◽

Phrenic Nerve Paralysis

Abstract Background Pulmonary vein isolation (PVI) is the main ablation approach for paroxysmal atrial fibrillation (AF). The superiority of the second-generation cryoballoon (2G-CB) ablation over contact force-sensing radiofrequency (CF-RF) ablation is unclear. Therefore, we sought to investigate the superiority of 2G-CB ablation over CF-RF ablation in paroxysmal AF patients. Methods A systematic review and meta-analysis study was conducted. We included 12 studies involving 1419 patients. The overall effects were quantified using pooled odds ratio (OR) or mean difference (MD) for categorical or continuous variables. Results Freedom from atrial tachyarrhythmias (ATAs) (OR = 0.88; 95% confidence interval [CI] = 0.68 to 1.15; p = 0.35), freedom from AF (OR = 0.93; 95% CI = 0.64 to 1.34; p = 0.7), and acute PVI (OR = 1.00; 95% CI = 1.00 to 1.00; p = 0.99) between 2G-CB ablation and CF-RF ablation were not different. The 2G-CB ablation took shorter procedure time (MD = -18.78 minutes; 95% CI = -27.72 to -9.85 minutes; p < 0.01) and relative similar fluoroscopy time (MD = 2.66 minutes; 95% CI = -0.52 to 5.83 minutes; p = 0.10). Phrenic nerve paralysis was higher in 2G-CB ablation group (OR = 7.25; 95% CI = 2.37 to 22.16; p = < 0.005). Conclusion The 2G-CB ablation was not superior to CF-RF ablation in paroxysmal AF in terms of acute PVI, freedom from ATAs, and freedom from AF. The 2G-CB ablation procedure can be performed faster than CF-RF ablation, although correlated with a higher phrenic nerve paralysis.

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