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

• Published in: BMC medicine Vol. 20; no. 1; pp. 193 - 13
• Main Authors: Charitakis, Emmanouil, Metelli, Silvia, Karlsson, Lars O, Antoniadis, Antonios P, Rizas, Konstantinos D, Liuba, Ioan, Almroth, Henrik, Hassel Jönsson, Anders, Schwieler, Jonas, Tsartsalis, Dimitrios, Sideris, Skevos, Dragioti, Elena, Fragakis, Nikolaos, Chaimani, Anna
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 31.05.2022; BioMed Central; BMC
• Subjects: Ablation; Antiarrhythmic drugs; Arrhythmia; Atrial fibrillation; Atrial Fibrillation - surgery; Cardiac arrhythmia; Cardiovascular disease; Care and treatment; Catheter ablation; Catheter Ablation - methods; Catheters; Clinical trials; Decision making; Denervation; Efficacy; Electrocardiography; Fibrillation; Ganglia; Humans; Life Sciences; Medical instruments; Meta-analysis; Mortality; Network Meta-Analysis; Patient outcomes; Patients; Pulmonary Veins - surgery; Radiofrequency ablation; Randomized Controlled Trials as Topic; Registries; Safety; Sensitivity analysis; Statistical analysis; Sweden; Efficacy; Antiarrhythmic drugs; Network meta-analysis; Safety; Atrial fibrillation; Catheter ablation
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-022-02385-2

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. PROSPERO registry number: CRD42020169494 .