Radiofrequency ablation vs. antiarrhythmic drug therapy as first line treatment of symptomatic atrial fibrillation: systematic review and meta-analysis
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AIMS: New evidence about first-line radiofrequency catheter ablation (RFA) in symptomatic atrial fibrillation (AF) has emerged. In a single study the comparative treatment effect is potentially diminished by the high rate of cross-over to the alternative therapy. Therefore, we conducted a systematic review and meta-analysis of the available data to further evaluate the efficacy and safety of RFA vs. antiarrhythmic drugs (AADs). METHODS AND RESULTS: Five databases were searched for randomized controlled trials comparing RFA and AAD therapy as first-line treatment of AF in August 2014. Three studies with 491 patients with recurrent symptomatic AF were included. The patients were relatively young and the majority of them had paroxysmal AF (98.7%) and no major comorbidity. Radiofrequency catheter ablation was associated with significantly higher freedom from AF recurrence compared with AAD therapy [risk ratio (RR) 0.63, 95% confidence interval (CI) 0.44-0.92, P = 0.02]. The difference in the rate of symptomatic AF recurrences was not statistically significant (RR 0.57, 95% CI 0.30-1.08, P = 0.09). There was one procedure-related death and seven tamponades with RFA, whereas symptomatic bradycardia was more frequent with AAD therapy. CONCLUSION: Radiofrequency catheter ablation seems to be more effective than medical therapy as first-line treatment of paroxysmal AF in relatively young and otherwise healthy patients, but may also cause more severe adverse effects. These findings support the use of RFA as first-line therapy in selected patients, who understand the benefits and risks of the procedure.
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Complication rates were similar between catheter ablation and antiarrhythmic drug therapy as first-line treatment for paroxysmal atrial fibrillation.
“Complication rates were similar, but ablation was performed in expert centres, justifying catheter ablation as first-line therapy in selected patients with paroxysmal AF who ask for interventional therapy.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [721]
As first-line treatment for paroxysmal atrial fibrillation, randomized trials showed only modestly improved rhythm outcome with catheter ablation compared to antiarrhythmic drug therapy.
“As first-line treatment for paroxysmal AF, randomized trials showed only modestly improved rhythm outcome with catheter ablation compared to antiarrhythmic drug therapy.585,[721][722][723]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [721]
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- Authors
- Hakalahti, A., Biancari, F., Nielsen, J. C., & Raatikainen, M. J. P.
- Affiliations
- Oulu University Hospital (FI)
- Aarhus University Hospital (DK)
- Tampere University Hospital (FI)
- Corresponding author
- Hakalahti, A.
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-02-01
- Volume
- 17
- Issue
- 3
- Pages
- 370-378
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2097321917
- Cited by
- 191
- References
- 37
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 14 · 2023: 16 · 2022: 24 · 2021: 30 · 2020: 20 · 2019: 13 · 2018: 20 · 2017: 19 · 2016: 17 · 2015: 5
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Foundation for Cardiovascular Research
- Sydäntutkimussäätiö
- Instrumentariumin Tiedesäätiö
- Tays
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, radiofrequency catheter ablation, antiarrhythmic drugs, first-line therapy, paroxysmal atrial fibrillation, atrial fibrillation recurrence, procedural complications, bradycardia, treatment efficacy and safety
- MeSH terms
- Anti-Arrhythmia Agents, Atrial Fibrillation, Humans, Treatment Outcome, Catheter Ablation, Patient Selection
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