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

BMC Medicine

Nikolaos Fragakis¹  Antonios P. Antoniadis¹  Henrik Almroth²  Emmanouil Charitakis²  Anders Hassel Jönsson²  Ioan Liuba²  Lars O. Karlsson²  Skevos Sideris³  Dimitrios Tsartsalis⁴  Jonas Schwieler⁵  Konstantinos D. Rizas⁶  Elena Dragioti⁷  Anna Chaimani⁸  Silvia Metelli⁸ 

[1] 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School;Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University;Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital;Department of Emergency Medicine, Hippokration Hospital;Heart and Vascular Theme, Karolinska University Hospital;Medizinische Klinik Und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-University Munich;Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University;Research Center of Epidemiology and Statistics (CRESS-U1153), Université Paris Cité, INSERM;

关键词: Network meta-analysis;    Atrial fibrillation;    Catheter ablation;    Efficacy;    Safety;    Antiarrhythmic drugs;   

DOI  :  10.1186/s12916-022-02385-2

来源: DOAJ

【 摘 要 】

Abstract Background 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). Methods 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. Results 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. Conclusions 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. Systematic review registration PROSPERO registry number: CRD42020169494 .

【 授权许可】

Unknown