Catheter ablation versus anti-arrhythmic drug therapy for the management of a trial fibrillation: a meta-analysis

Purposes The current study was a meta-analysis designed to compare the therapeutic efficacy and safety of catheter ablation with those of anti-arrhythmic drugs, over the short and long term. Methods Comparative studies (randomized controlled trials) of catheter ablation vs. anti-arrhythmic drugs for the treatment of AF were retrieved from MEDLINE and EM BASE. The primary (no recurrence of AF) and secondary (major adverse events) outcomes were compared by meta-analysis, with sub-group analysis of short-term (1 year or less) and long-term (>1 year) effects. Results Of the 223 studies originally identified, 214 were excluded (duplication, non-randomized design, lack of relevance or lack of usable data). Compared with anti-arrhythmic drug therapy, catheter ablation was associated with superior efficacy (odds ratio [OR], 9.41; 95 % confidence interval [95 % CI], 5.00–17.71; P < 0.01). Treatment success was higher for catheter ablation both in the short term (OR, 10.84; 95 % CI, 5.83–20.16; P < 0.001) and long term (OR, 7.65; 95 % CI, 1.97–29.73; P = 0.03). There was a trend toward a lower incidence of adverse events in the catheter ablation group (OR, 2.19; 95 % CI, 0.99–4.85), but this did not reach statistical significance ( P = 0.05). Conclusion Compared with anti-arrhythmic drugs, management of AF with catheter ablation showed superior efficacy in the short term that was maintained over the longer term.