Comparison of the Efficacy and Safety Endpoints of Five Therapies for Atrial Fibrillation: A Network Meta-Analysis

Frontiers in Cardiovascular Medicine

article

Tongyu Wang¹  Tingting Fang²  Zeyi Cheng³ 

[1] Department of Cardiovascular Medicine, The Fourth Affiliated Hospital of China Medical University;Department of Cardiology, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University;Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine

关键词: atrial fibrillation;    atrioventricular node ablation;    stroke;    recurrence;    radiofrequency ablation;   

DOI  :  10.3389/fcvm.2022.853149

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Introduction Atrial fibrillation (AF) is a prevalent arrhythmia that occurs in 2–4% of adults and poses a threat to human health. Thus, comparison of the efficacy and safety of therapies for AF is warranted. Here, we used network analysis to compare efficacy (arrhythmia recurrence and re-hospitalization) and safety (ischemic cerebral vascular events, all-cause mortality, and cardiovascular mortality) endpoints among five major therapies for AF. Methods The PubMed, Cochrane, and Embase databases were searched, and relevant literature was retrieved. Only studies that made comparisons among the therapies of interest and involved patients with AF were included. Pairwise comparisons and frequentist method (SUCRA plot) analyses were conducted. Results In total, 62 studies were included in the pooled analysis. In pairwise comparisons, atrioventricular nodal ablation plus permanent pacemaker (AVN + PPM) was associated with a significantly higher risk of atrial arrhythmia recurrence than surgical ablation [odds ratio (OR): 23.82, 95% confidence interval (CI): 1.97–287.59, fixed-effect model; 3.82, 95% CI: 1.01–559.74, random-effects model]. Furthermore, radiofrequency ablation was associated with a significantly lower risk of cardiovascular mortality than medication in pairwise comparison (OR: 0.49, 95% CI: 0.29–0.83, fixed-effect model; OR: 0.49, 95% CI: 0.27–0.9, random-effects model). Frequentist analysis indicated that AVN + PPM had the best performance in reducing the risk of safety and efficacy endpoints. Conclusion Non-pharmaceutical therapies showed superior performance to traditional drug therapy in lowering the risk of safety and efficiency endpoint events. AVN + PPM performed best in reducing the risk of safety and efficacy endpoints.

【 授权许可】

CC BY