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Association of catheter ablation for atrial fibrillation with mortality and stroke: A systematic review and meta-analysis

Barra, S; Baran, J; Narayanan, K; Boveda, S; Fynn, S; Heck, P; Grace, A; ... Providência, R; + view all (2018) Association of catheter ablation for atrial fibrillation with mortality and stroke: A systematic review and meta-analysis. International Journal of Cardiology , 266 pp. 136-142. 10.1016/j.ijcard.2018.03.068. Green open access

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Abstract

BACKGROUND: Maintenance of sinus rhythm has been associated with lower mortality, but whether atrial fibrillation (AF) ablation per se benefits hard outcomes such as mortality and stroke is still debated. OBJECTIVE: To determine whether AF ablation is associated with a reduction in all-cause mortality and stroke compared with medical therapy alone. METHODS: Literature search looking for both randomized and observational studies comparing AF catheter ablation vs. medical management. Data pooled using random-effects. Risk ratios (RR) with 95% confidence intervals (CI) used as a measure of treatment effect. The primary and secondary outcomes were all-cause mortality and occurrence of cerebrovascular events during follow-up, respectively. RESULTS: Thirty studies were eligible for inclusion, comprising 78,966 patients (25,129 receiving AF ablation and 53,837 on medical treatment) and 233,990 patient-years of follow-up. The pooled data of studies revealed that ablation was associated with lower risk of all-cause mortality: 5.7% vs. 17.9%; RR = 0.44, 95% CI 0.32–0.62, p < 0.001. In a sensitivity analysis by study design, a survival benefit of AF ablation was seen in randomized studies, with no heterogeneity (mortality risk 4.2% vs. 8.9%; RR = 0.55, 95% CI 0.39–0.79, p = 0.001, I2= 0%), and also in observational studies, but with marked heterogeneity (6.1% vs. 18.3%; RR = 0.39, 95% CI 0.26–0.59, p < 0.001, I2= 95%). The mortality benefit in randomized studies was mainly driven by trials performed in patients with left ventricular (LV) dysfunction and heart failure. The pooled risk of a cerebrovascular event was lower in patients receiving AF ablation (2.3% vs. 5.5%; RR = 0.57, 95% CI 0.46–0.70, p < 0.001, I2= 62%), but no difference was seen in randomized trials (2.2% vs. 2.1%; RR = 0.94, 95% CI 0.46–1.94, p = 0.87, I2= 0%). CONCLUSIONS: Ablation of atrial fibrillation associates with a survival benefit compared with medical treatment alone, although evidence is restricted to the setting of heart failure and LV systolic dysfunction.

Type: Article
Title: Association of catheter ablation for atrial fibrillation with mortality and stroke: A systematic review and meta-analysis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ijcard.2018.03.068
Publisher version: http://dx.doi.org/10.1016/j.ijcard.2018.03.068
Language: English
Additional information: © 2018 Elsevier B.V.This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Ablation, Atrial fibrillation, Mortality, Stroke, Meta-analysis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10051906
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