Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: a network meta-analysis

Charitakis, Emmanouil and Metelli, Silvia and Karlsson, Lars O. and Antoniadis, Antonios P. and Rizas, Konstantinos D. and Liuba, Ioan and Almroth, Henrik and Hassel Jönsson, Anders and Schwieler, Jonas and Tsartsalis, Dimitrios and Sideris, Skevos and Dragioti, Elena and Fragakis, Nikolaos and Chaimani, Anna (2022) Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: a network meta-analysis. BMC Medicine, 20 (1). ISSN 1741-7015

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There is no consensus on the most efficient catheter ablation (CA) strategy for patients with atrial fibrillation (AF). The objective of this study was to compare the efficacy and safety of different CA strategies for AF ablation through network meta-analysis (NMA).

A systematic search of PubMed, Web of Science, and CENTRAL was performed up to October 5th, 2020. Randomized controlled trials (RCT) comparing different CA approaches were included. Efficacy was defined as arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of 6 months.

In total, 67 RCTs (n = 9871) comparing 19 different CA strategies were included. The risk of recurrence was significantly decreased compared to pulmonary vein isolation (PVI) alone for PVI with renal denervation (RR: 0.60, CI: 0.38–0.94), PVI with ganglia-plexi ablation (RR: 0.62, CI: 0.41–0.94), PVI with additional ablation lines (RR: 0.8, CI: 0.68–0.95) and PVI in combination with bi-atrial modification (RR: 0.32, CI: 0.11–0.88). Strategies including PVI appeared superior to non-PVI strategies such as electrogram-based approaches. No significant differences in safety were observed.

This NMA showed that PVI in combination with additional CA strategies, such as autonomic modulation and additional lines, seem to increase the efficacy of PVI alone. These strategies can be considered in treating patients with AF, since, additionally, no differences in safety were observed. This study provides decision-makers with comprehensive and comparative evidence about the efficacy and safety of different CA strategies.

Item Type: Article
Subjects: T Technology > T Technology (General)
Depositing User: APLOS Library
Date Deposited: 04 Jun 2022 10:23
Last Modified: 04 Jun 2022 10:23

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