scholarly journals Ablation vs Medication as Initial Therapy for Paroxysmal Atrial Fibrillation: An Updated Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Jakrin Kewcharoen ◽  
Narut Prasitlumku ◽  
Ronpichai Chokesuwattanaskul ◽  
Ruiyang Yi ◽  
Krit Jongnarangsin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Paroxysmal Atrial Fibrillation ◽  
Meta Analysis ◽  
Initial Therapy ◽  
Controlled Trials ◽  
Free Survival ◽  
Randomized Controlled

Background: Recent randomized controlled trials (RCT) suggest that ablation is superior to antiarrhythmic drugs (AAD) as an initial therapy for paroxysmal atrial fibrillation (pAF) to prevent arrhythmia recurrences. We performed an updated meta-analysis of RCTs, to include recent data from cryoballoon-based ablation, and to compare arrhythmia-free survival and adverse events between ablation and AAMs. Methods: We searched MEDLINE and EMBASE from inception to December 2020. We included RCT comparing patients with pAF undergoing ablation or receiving AADs as an initial therapy. We combined data using the random-effects model to calculate hazards ratio (HR) for arrhythmia-free survival and odds ratio (OR) for adverse events. Results: Five studies from 2005-2020 involving 985 patients were included (495 patients and 490 patients underwent ablation and medication as initial therapy, respectively). Patients who underwent ablation had higher freedom from atrial tachyarrhythmias (AT) during the 12-24 months follow-up period (pooled HR=0.48, 95% CI:0.40-0.59, p<0.001) (Figure 2). In a subgroup analysis of ablation method used, both cryoablation group (pooled HR=0.49, 95% CI:0.38-0.64, p<0.001) (Figure 2A) and radiofrequency ablation group (pooled HR=0.47, 95%CI:0.35-0.64, p<0.001) (Figure 2B) showed reduction in AT recurrence compared to AAD group. There were no differences in adverse events including cerebrovascular accident, pericardial effusion or tamponade, pulmonary vein stenosis, acute coronary syndrome, deep vein thrombosis and pulmonary embolism, and bradycardia requiring a pacemaker. Conclusion: Catheter ablation (both cryoablation and radiofrequency ablation) is superior to AAD as an initial therapy for pAF in efficacy for reducing AT recurrences without a compromise in adverse events.

Comparison of Radiofrequency Ablation and Cryoablation for Paroxysmal Atrial Fibrillation：A Meta-Analysis of Randomized Controlled Trials. (Preprint)

2021 ◽  
Author(s):  
Xiaoxv Yang ◽  
Hui-Yuan Zhou ◽  
Ya-Le Lu
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Randomized Controlled Trials ◽  
Paroxysmal Atrial Fibrillation ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
One Year ◽  
Better Than

BACKGROUND Some studies have compared the effects of radiofrequency current energy and cryoballoon in patients with paroxysmal atrial fibrillation. The results on the rate of atrial fibrillation and the incidence of complications one year after ablation were inconsistent with these studies. OBJECTIVE The purpose of this study was to evaluate whether the efficacy and safety of cryoballoon (CB) are better than that of radiofrequency ablation(RF) for pulmonary vein isolation in the treatment of paroxysmal atrial fibrillation(PAF). METHODS The Pubmed and Cochrane Library databases were searched for randomized controlled trials(RCTs) since inception through August 2020. The efficacy outcome was success rate one year after ablation. Rate of complications safety outcome. Included studies were RCTs in adults with PAF in which CB therapy was compared to RF therapy. Two investigators extracted data from the selected studies and assessed the risk of bias. RESULTS A total of 6 RCTs with 1681 individuals were included in the analysis. Pooled analyses indicated that CB ablation had a lower rate of the free-from atrial fibrillation(AF) one year after catheter ablation than RF therapy,but not statistically significant (OR: 0.88; 95% CI: 0.57 to 1.36;p=0.57). There was a higher rate of complications in the CB group,but not significant (OR: 1.27;95% CI: 0.73 to 2.22;p=0.39). CONCLUSIONS This meta-analysis shows that CB is not better than RF for patients with paroxysmal atrial fibrillation, and the incidence of complications is not lower than RF.

scholarly journals Ranolazine alone or as a complement to the amiodarone for both prevention and cardioversion of atrial fibrillation: A meta-analysis of the literature

2017 ◽  
Author(s):  
Renato De Vecchis ◽  
Carmelina Ariano
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Events ◽  
Sinus Rhythm ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Controlled Trials ◽  
Cabg Surgery ◽  
Randomized Controlled ◽  
New Onset

Introduction Recent evidence from relatively small randomized controlled trials would seem to support a useful role of ranolazine for the prevention and treatment of atrial fibrillation (AF). The present study is aimed at providing information about the possible beneficial anti-arrhythmic properties of&nbsp;&nbsp; ranolazine. In particular, the meta-analysis carried out in this study focuses on the application of ranolazine to prophylaxis and treatment of atrial fibrillation.Methods Both&nbsp; randomized controlled trials (RCTs) and&nbsp; non randomized observational&nbsp; studies concerning the effects of ranolazine on AF were included in the meta-analysis. In each of the considered studies, a comparison was made between a group of patients taking ranolazine and a second group treated instead with another antiarrhythmic therapy , or assigned to placebo. Efficacy outcomes were the risk of new- onset AF, the probability of conversion to sinus rhythm of patients with recent occurrence(&le; 48 h)of AF and the time to conversion to sinus rhythm. Safety endpoints were death, adverse events, QTc&nbsp; prolongation and hypotension.Results Ten studies ( 8 RCTs and 2 nonrandomized observational studies) were gathered on the whole. &nbsp;Ranolazine was effective in preventing&nbsp;the occurrence of AF when compared to controls (RR= 0.60; 95% CI: 0.43&ndash;0.83; p = 0.002). Subgroup analysis showed a more &nbsp;pronounced preventive effect &nbsp;of ranolazine against AF in the postoperative setting of coronary artery bypass grafting(CABG) surgery (RR= 0.39; 95% CI: 0.18-0.83; p=0.02) when compared to non- postoperative AF (RR= 0.76; 95% CI: 0.63-0.92; p=0.04). Ranolazine enhanced the chances of successful cardioversion when added to intravenous amiodarone compared to amiodarone alone &nbsp;(RR 1.18; 95% CI: 1.05&ndash;1.33; p = 0.004) and &nbsp;significantly decreased the &nbsp;time to cardioversion(SMD= &minus;10.35 h; 95% CI: &minus;18.13 hours to &minus; 2.57 hours; p &lt; 0.001). Overall risks of death, adverse events, and QTc prolongation were shown to be similar in the comparison between patients treated with ranolazine and controls. Conclusions Ranolazine given orally at appropriate doses showed the property to significantly quicken the conversion of AF to sinus rhythm when combined with the iv amiodarone, compared to iv amiodarone alone . Furthermore, in patients in sinus rhythm, ranolazine&nbsp;&nbsp; proved to reduce the frequency of new onset AF as well as of its recurrences, especially in patients undergone CABG surgery, known to be at high risk of developing postoperative AF. In addition, ranolazine use seems to be safe and associated with relatively few adverse events.

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