The Clinical Benefits and Mortality Reduction Associated With Catheter Ablation in Subjects With Atrial Fibrillation: A Systematic Review and Meta-Analysis.

OBJECTIVES: This study sought to compare the efficacy and safety of catheter ablation (CA) with those of medical therapy (MT) for the treatment of atrial fibrillation (AF).

BACKGROUND: The preferred therapeutic strategy for subjects with AF remains unclear.

METHODS: A total of 17 randomized controlled trials were selected using Medline, EMBASE, and CENTRAL (September 1998 to 2 February 2018). The analysis was stratified at the trial level according to the following: 1) patients with AF and heart failure (HF); and 2) patients with AF without HF.

RESULTS: A total of 2,272 patients with AF (775 patients with HF and 1,497 patients without HF) participated in this analysis. In patients with HF, CA was associated with significant relative risk reduction in all-cause mortality (risk ratio [RR]: 0.52; 95% confidence interval [CI]: 0.36 to 0.76; p < 0.001; I2  = 0), recurrent atrial arrhythmia (RR: 0.44; 95% CI: 0.31 to 0.61; p <0.001; I2  = 56), and cardiac hospitalization (RR: 0.63; 95% CI: 0.46 to 0.87; p = 0.01; I2  = 43) compared with MT. Conversely, in patients without HF, CA had no beneficial effect on the risk of all-cause mortality compared with MT (RR: 0.88, 95% CI: 0.29 to 2.61; p = 0.81; I2  = 0). However, CA reduced the risk of recurrent atrial arrhythmia (RR: 0.40; 95% CI: 0.31 to 0.52; p < 0.001; I2  = 73) and cardiac hospitalization (RR: 0.32; 95% CI: 0.23 to 0.45; p < 0.001; I2  = 0) in patients without HF.

CONCLUSIONS: This meta-analysis suggests that although CA reduced the risk of cardiac hospitalization and recurrent atrial arrhythmia both in subjects with HF and in subjects without HF, the reduction in all-cause mortality was limited to subjects with HF only.