Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation: Meta-Analysis of Quality of Life, Morbidity, and Mortality

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• 作者：Konstantinos C. Siontis ; MD^a ; John P.A. Ioannidis ; MD ; DSc^b ; ^c ; ^d ; ^e ; George D. Katritsis ; MB ; ChB ; BSc^f ; Peter A. Noseworthy ; MD^g ; Douglas L. Packer ; MD^g ; John D. Hummel ; MD^h ; Pierre Jais ; MD ; PhDⁱ ; Rungroj Krittayaphong ; MD^j ; Llius Mont ; MD ; PhD^k ; Carlos A. Morillo ; MD^l ; Jens Cosedis Nielsen ; MD^m ; Hakan Oral ; MDⁿ ; Carlo Pappone ; MD ; PhD^o ; Vincenzo Santinelli ; MD^o ; Rukshen Weerasooriya ; MBBS^p ; David J. Wilber ; MD^q ; Bernard J. Gersh ; MB ; ChB ; DPhil^g ; Mark E. Josephson ; MD^r ; Demosthenes G. Katritsis ; MD ; PhD^r ; ^{dkatrits@bidmc.harvard.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：antiarrhythmic drug therapy ; atrial fibrillation ; meta-analysis ; radiofrequency ablation
• 刊名：JACC: Clinical Electrophysiology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：2
• 期：2
• 页码：170-180
• 全文大小：490 K

文摘

The aim of this study was to perform a collaborative meta-analysis of published and unpublished quality-of-life, morbidity, and mortality data from randomized controlled trial comparisons of radiofrequency ablation (RFA) and antiarrhythmic drug therapy (AAD) in symptomatic atrial fibrillation.

Background

RFA is superior to AAD in decreasing recurrences of atrial fibrillation, but the effects on other clinical outcomes are not well established.

Methods

The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random-effects summary estimates were calculated as standardized mean differences and risk ratios with 95% confidence intervals for continuous and binary outcomes, respectively. Fixed effects were used in subgroup analyses.

Results

Twelve randomized controlled trials (n = 1,707 patients) were included. RFA led to greater improvements in 4 36-Item Short Form Health Survey areas and the symptom frequency score from baseline to 3 months. In all quality-of-life metrics, there was a trend toward diminution of the differences between the 2 approaches with follow-up. There were 7 of 866 (5 in a study using phased RFA) and 0 of 704 strokes in the RFA and AAD arms, respectively (p = 0.02, Fisher exact test). Bleeding and mortality events were not significantly different between the 2 arms. There was high heterogeneity for hospitalizations, with decreased hospitalization risk with RFA when it was not first-line therapy (risk ratio: 0.34; 95% confidence interval: 0.24 to 0.46) and increased risk as first-line therapy (risk ratio: 1.22; 95% confidence interval: 1.03 to 1.45).

Conclusions

RFA demonstrates an early but nonsustained superiority over AAD for the improvement of quality of life. There are no obvious differences in other clinical outcomes, and the periprocedural stroke risk is non-negligible.