Assessment of Catheter Ablation or Antiarrhythmic Drugs for
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Early rhythm control of atrial fibrillation (AF) with either antiarrhythmic drugs (AADs) or catheter ablation has been reported to improve cardiovascular outcomes compared with usual care; however, the optimal therapeutic modality to achieve early rhythm control is unclear.

This study aimed to assess the safety and efficacy of AF ablation as first-line therapy when compared with AADs in patients with paroxysmal AF.

Data sources were PubMed/MEDLINE, Scopus, Google Scholar, and various major scientific conference sessions.

Randomized clinical trials (RCTs) published in English that had at least 12 months of follow-up and compared clinical outcomes of ablation vs AADs as first-line therapy in adults with AF were included. The quality of individual studies was assessed using the Cochrane risk of bias tool. Six RCTs met inclusion criteria, including 1212 patients.

Two investigators independently extracted data. Reporting was performed in compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines.

Results:
-- A total of 6 RCTs involving 1212 patients with AF were included (609 were randomized to AF ablation and 603 to drug therapy; mean age, 56 years).

-- Compared with AADs, catheter ablation use was associated with reductions in recurrent atrial arrhythmia, with a number needed to treat with ablation to prevent 1 arrhythmia of 5.

-- Use of ablation was also associated with reduced symptomatic atrial arrhythmia and hospitalization with no significant difference in serious adverse events between the groups.

Conclusively, in this meta-analysis of randomized clinical trials including first-line therapy of patients with paroxysmal AF, catheter ablation compared with antiarrhythmic drugs was associated with reductions in recurrence of atrial arrhythmias and hospitalizations, with no difference in major adverse events.

Source: https://jamanetwork.com/journals/jamacardiology/article-abstract/2779384
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