Mortality benefit of catheter ablation versus medical therapy in atrial fibrillation: An RCT only meta-analysis

Introduction: Catheter ablation for atrial fibrillation (AF) in comparison to medical therapy alone is known to improve freedom from arrhythmia and quality of life, but the benefit regarding mortality is unclear. The publication of several recent large randomized controlled trials (RCT) comparing ablation with medical therapy has warranted an updated meta-analysis.

Methods: We sought to compare the effectiveness of catheter ablation versus medical therapy only in patients with AF. MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched from inception until 04/30/2021. Relevant RCTs comparing catheter ablation versus medical therapy in patients with AF were selected.

Results: A total of 24 RCTs involving 5730 adult patients were included (2992 in catheter ablation and 2738 in medical therapy). There was a reduction in all-cause mortality with catheter ablation compared with medical therapy only (risk ratio (RR) 0.70 [95% confidence interval (CI) 0.55-0.89]; p = .003). Catheter ablation also demonstrated a reduction in hospitalizations (RR 0.50 [95% CI 0.36-0.70]; p < .001), improvement in left ventricular ejection fraction (LVEF) (mean difference [MD] + 5.94% [95% CI 0.40-11.48] p = .04), greater freedom from atrial arrhythmia (RR 2.23 [95% CI 1.79-2.76]; p < .001), and AF (RR 1.95 [95% CI 1.44-2.66]; p < .001). In subgroup analysis, catheter ablation demonstrated a significant reduction in mortality and hospitalizations among patients with reduced LVEF, and when ablation was compared with antiarrhythmic drug use.

Conclusions: In comparison to medical therapy only, catheter ablation for atrial fibrillation reduces mortality, hospitalizations, and increases freedom from arrhythmia.