Catheter Ablation vs. Medical Therapy as First-line for Treatment of Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review
Syeda Sehrish Hassan
Fatima Jinnah Medical University, Pakistan.
Abiodun O. Aboaba
School of Medicine, Avalon University, Curacao.
Omar Rahim *
Kabir Medical College, Pakistan.
Shaymaa E. Abdelmalek
Faculty of Medicine, Suez Canal University, Egypt.
Prerna Singh
J. J. M. Medical College, Rajiv Gandhi University of Health Sciences, India.
Taiwo Ogundipe
College of Medicine, Lagos State University, Nigeria.
Probal Talukdar
Rangpur Medical College, Bangladesh.
Gideon Asaolu
School of Medicine, Windsor University, Saint Kitts and Nevis.
Epiniah S. Choga
Caribbean Medical University (CMU), Curacao.
Daniel Kasho Williams
School of Medicine, Windsor University, Saint Kitts and Nevis.
Bolude Oludele Oluwade
College of Medicine, Lagos State University, Nigeria.
Manel Bouchama
University of Algiers of Medical Science, Algeria.
Yishwerer Karadapanddy
Mahsa University, Kuala Lumpur, Malaysia.
Patrick Batti
American University of Antigua (AUA), Antigua and Barmuda.
Adewale Mark Adedoyin
College of Medicine, Lagos State University, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Introduction: The outcomes of Catheter Ablation (CA) and antiarrhythmic drugs (AAD) as the first-line treatment of paroxysmal Atrial Fibrillation (AF) are unclear. The current systematic review reports the evidence on efficacy outcomes of Radiofrequency Ablation (RFA) versus antiarrhythmic drugs (AAD) among these patients.
Methods: Three databases, including PubMed, Cochrane, and Google Scholar, were searched by three independent reviewers to identify relevant randomized control trials (RCTs).
Results: A total of 1,145 patients across five studies were assessed in this systematic review. Among these patients, 577 were randomized to receive ablation, and 568 were randomized to receive AAD. The recurrence rate was significantly higher among patients who received AAD at 1-year and 2-year follow-ups. The health-related quality of life (HR-QoL) was significantly better in the patients who received ablation therapy. The incidence of serious adverse events was 14 (6.4%) in the ablation group and 9 (4.3%) in the AAD group.
Conclusion: CA seems promising for managing AF in terms of any AF recurrence, hospitalization, and quality of life. There was no increase in side effects compared to AAD.
Keywords: Radiofrequency ablation, antiarrhythmic drugs, atrial fibrillation, recurrence, hospitalization, adverse events