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.
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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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