Impact of atrial fibrillation catheter ablation on mortality, stroke, and heart failure hospitalizations: A meta-analysis.
all-cause mortality, stroke, hard clinical outcomes
atrial fibrillation
catheter ablation
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
11
10
2019
revised:
20
01
2020
accepted:
05
02
2020
pubmed:
3
3
2020
medline:
13
4
2021
entrez:
3
3
2020
Statut:
ppublish
Résumé
The impact of atrial fibrillation catheter ablation (AFCA) on hard clinical endpoints remains controversial. Our aim was to conduct a random-effect model meta-analysis on efficacy data from high-quality large matched database/registry studies and randomized clinical trials. We compared long-term all-cause mortality, stroke, and hospitalization for heart failure in patients undergoing AFCA vs patients treated with medical therapy alone (rhythm and/or rate control medications) in a general AF population. PubMed/MEDLINE and Embase databases were screened and a total of nine studies were selected (one randomized clinical trial-CABANA-and eight large matched population studies). A total of 241 372 patients (27 711 in the ablation group, 213 661 in the nonablation group) were included. After a median follow-up of 3.5 years, AFCA decreased the risk of mortality (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.54-0.72; I Based on the currently available efficacy and effectiveness evidence, AFCA significantly reduces the risk of death, stroke, and hospitalization compared with medical therapy alone.
Sections du résumé
BACKGROUND
The impact of atrial fibrillation catheter ablation (AFCA) on hard clinical endpoints remains controversial.
OBJECTIVE
Our aim was to conduct a random-effect model meta-analysis on efficacy data from high-quality large matched database/registry studies and randomized clinical trials. We compared long-term all-cause mortality, stroke, and hospitalization for heart failure in patients undergoing AFCA vs patients treated with medical therapy alone (rhythm and/or rate control medications) in a general AF population.
METHODS AND RESULTS
PubMed/MEDLINE and Embase databases were screened and a total of nine studies were selected (one randomized clinical trial-CABANA-and eight large matched population studies). A total of 241 372 patients (27 711 in the ablation group, 213 661 in the nonablation group) were included. After a median follow-up of 3.5 years, AFCA decreased the risk of mortality (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.54-0.72; I
CONCLUSION
Based on the currently available efficacy and effectiveness evidence, AFCA significantly reduces the risk of death, stroke, and hospitalization compared with medical therapy alone.
Substances chimiques
Anti-Arrhythmia Agents
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1040-1047Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347:1825-1833.
Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347:1834-1840.
Wazni OM, Marrouche NF, Martin DO, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA. 2005;293:2634-2640.
Mont L, Bisbal F, Hernández-Madrid A, et al. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J. 2013;35:501-507.
Khan SU, Rahman H, Talluri S, Kaluski E. The clinical benefits and mortality reduction associated with catheter ablation in subjects with atrial fibrillation: a systematic review and meta-analysis. JACC Clin Electrophysiol. 2018;4:626-635.
Packer DL, Mark DB, Robb RA, et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019;321(13):1261-1274.
Kalman JM, Sanders P, Rosso R, Calkins H. Should we perform catheter ablation for asymptomatic atrial fibrillation? Circulation. 2017;136:490-499.
Noseworthy PA, Gersh BJ, Kent DM, et al. Atrial fibrillation ablation in practice: assessing CABANA generalizability. Eur Heart J. 2019;40:1257-1264.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.
Higgins JPT, Thomas J, Chandler J et al., eds. Cochrane Handbook for Systematic Reviews of Interventions. 2 ed. Chichester, UK: John Wiley & Sons; 2019.
Marrouche NF, Brachmann J, Andresen D, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378:417-427.
Di Biase L, Mohanty P, Mohanty S, et al. Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device: results from the AATAC multicenter randomized trial. Circulation. 2016;133:1637-1644.
Hunter RJ, Berriman TJ, Diab I, et al. A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial). Circ Arrhythm Electrophysiol. 2014;7:31-38.
Jones DG, Haldar SK, Hussain W, et al. A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. J Am Coll Cardiol. 2013;61:1894-1903.
Jaïs P, Cauchemez B, Macle L, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation. 2008;118:2498-2505.
Cosedis Nielsen J, Johannessen A, Raatikainen P, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med. 2012;367:1587-1595.
Stabile G, Bertaglia E, Senatore G, et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study). Eur Heart J. 2005;27:216-221.
Wilber DJ, Pappone C, Neuzil P, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010;303:333-340.
Hunter RJ, McCready J, Diab I, et al. Maintenance of sinus rhythm with an ablation strategy in patients with atrial fibrillation is associated with a lower risk of stroke and death. Heart. 2012;98:48-53.
Bunch TJ, Crandall BG, Weiss JP, et al. Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation. J Cardiovasc Electrophysiol. 2011;22:839-845.
Reynolds MR, Gunnarsson CL, Hunter TD, et al. Health outcomes with catheter ablation or antiarrhythmic drug therapy in atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2012;5:171-181.
Chang C-H, Lin J-W, Chiu F-C, Caffrey JL, Wu L-C, Lai M-S. Effect of radiofrequency catheter ablation for atrial fibrillation on morbidity and mortality: a nationwide cohort study and propensity-score analysis. Circ Arrhythm Electrophysiol. 2014;7:76-82.
Karasoy D, Gislason GH, Hansen J, et al. Oral anticoagulation therapy after radiofrequency ablation of atrial fibrillation and the risk of thromboembolism and serious bleeding: long-term follow-up in nationwide cohort of Denmark. Eur Heart J. 2014;36:307-315.
Friberg L, Tabrizi F, Englund A. Catheter ablation for atrial fibrillation is associated with lower incidence of stroke and death: data from Swedish health registries. Eur Heart J. 2016;37:2478-2487.
Saliba W, Schliamser JE, Lavi I, Barnett-Griness O, Gronich N, Rennert G. Catheter ablation of atrial fibrillation is associated with reduced risk of stroke and mortality: a propensity score-matched analysis. Heart Rhythm. 2017;14:635-642.
Joza J, Samuel M, Jackevicius CA, et al. Long-term risk of stroke and bleeding post-atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2018;29:1355-1362.
Srivatsa UN, Xing G, Amsterdam E, et al. California study of ablation for atrial fibrillation: re-hospitalization for cardiac events (CAABL-CE). J Atr Fibrillation. 2018:11.
Srivatsa UN, Danielsen B, Amsterdam EA, et al. CAABL-AF (California Study of Ablation for Atrial Fibrillation) Mortality and Stroke, 2005 to 2013. Circ Arrhythm Electrophysiol. 2018;11:e005739.
Anselmino M, Matta M, D'ascenzo F, et al. Catheter ablation of atrial fibrillation in patients with left ventricular systolic dysfunction: a systematic review and meta-analysis. Circ Arrhythm Electrophysiol. 2014;7(6):1011-1018.
Barra S, Baran J, Narayanan K, et al. Association of catheter ablation for atrial fibrillation with mortality and stroke: A systematic review and meta-analysis. Int J Cardiol. 2018;266:136-142.