Cited by 847Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studies

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Treatment of Atrial Fibrillation With Antiarrhythmic Drugs or Radiofrequency Ablation: Two Systematic Literature Reviews and Meta-Analyses

Calkins, Hugh, Reynolds, Matthew R., Spector, Peter, Sondhi, Manu, Xu, Yingxin, Martin, Amber, Williams, Catherine J., Sledge, Isabella·2009·Circulation Arrhythmia and Electrophysiology

DOI 10.1161/circep.108.824789

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Abstract

BACKGROUND: Although radiofrequency catheter ablation (RFA) has evolved from an experimental procedure to an important treatment option for atrial fibrillation, the relative safety and efficacy of catheter ablation relative to that of antiarrhythmic drug (AAD) therapy has not been established. METHODS AND RESULTS: Two separate systematic reviews were conducted: one on RFA and the other on AAD to provide accurate and broadly representative estimates of the clinical efficacy and safety of both therapies in the treatment of atrial fibrillation. Electronic searches were conducted in EMBASE and MEDLINE from 1990 to 2007. For the RFA review, all study designs were accepted. For the AAD review, articles were limited to prospective studies on the following drugs of interest: amiodarone, dofetilide, sotalol, flecainide, and propafenone. Data were extracted by 1 reviewer, with a second reviewer performing independent confirmation of extracted data. Sixty-three RFA and 34 AAD studies were included in the reviews. Patients enrolled in RFA studies tended to be younger (mean age, 55 versus 62 years), had longer duration of atrial fibrillation (6.0 versus 3.1 years), and had failed a greater number of prior drug trials (2.6 versus 1.7). The single-procedure success rate of ablation off AAD therapy was 57% (95% CI, 50% to 64%), the multiple procedure success rate off AAD was 71% (95% CI, 65% to 77%), and the multiple procedure success rate on AAD or with unknown AAD usage was 77% (95% CI, 73% to 81%). In comparison, the success rate for AAD therapy was 52% (95% CI, 47% to 57%). A major complication of catheter ablation occurred in 4.9% of patients. Adverse events for AAD studies, although more common (30% versus 5%), were less severe. CONCLUSIONS: Studies of RFA for treatment of atrial fibrillation report higher efficacy rates than do studies of AAD therapy and a lower rate of complications.

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10.1161/circ.98.23.2574 · DOI

Sorted by citations

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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“Most patients require more than one procedure to achieve symptom control.(713,726,728) In general, better rhythm outcome and lower procedure-related complications can be expected in younger patients with a short history of AF and frequent, short AF episodes in the absence of significant structural heart disease.”
Influential
Guidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq278 · Cited by 5,924
2012 focused update of the ESC Guidelines for the management of atrial fibrillation
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2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)
Gelder, I. C. V., Rienstra, M., Bunting, K. V., Casado-Arroyo, R., Caso, V., Crijns, H. J. G. M., Potter, T. J. R. D., Dwight, J., Guasti, L., Hanke, T., et al. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae176 · Cited by 3,594
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2012 focused update of the ESC Guidelines for the management of atrial fibrillation
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“AF catheter ablation is useful for symptomatic paroxysmal AF refractory or intolerant to at least 1 class I or III antiarrhythmic medication when a rhythm control strategy is desired (154-160).”
Guidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · EP Europace · doi:10.1093/europace/euq350 · Cited by 1,764
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Calkins, H. G., Kück, K., Cappato, R., Brugada, J., Camm, A. J., Chen, S., Crijns, H. J. G. M., Damiano, R. J., Davies, D. W., Dimarco, J., et al. (2012) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-012-9672-7 · Cited by 1,685
“meta-analyses examined the safety and efficacy of catheter ablation of AF and antiarrhythmic drug therapy.(512) The results of 63 RF ablation studies were included in these analyses.”
Result
Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation
Packer, D. L., Mark, D. B., Robb, R. A., Monahan, K. H., Bahnson, T. D., Poole, J. E., Noseworthy, P. A., Rosenberg, Y., Jeffries, N. O., Mitchell, L. B., et al. (2019) · JAMA · doi:10.1001/jama.2019.0693 · Cited by 1,538
2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design
Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S.-A., Crijns, H. J. G., Damiano, R. J., Davies, D. W., DiMarco, J., et al. (2012) · Heart Rhythm · doi:10.1016/j.hrthm.2011.12.016 · Cited by 1,456
Self-citation
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403
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“The many trials comparing AF ablation with AADs for second-line rhythm control have been evaluated in a number of meta-analyses and technology assessments.(262,1031,1032) Pooling of results across trials indicates that AF ablation is clearly superior to AAD therapy for the maintenance of sinus rhythm.”
Background
Inflammation and the pathogenesis of atrial fibrillation
Hu, Y., Chen, Y., Lin, Y., & Chen, S. (2015) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2015.2 · Cited by 1,122
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
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Cryoballoon Ablation of Pulmonary Veins for Paroxysmal Atrial Fibrillation
Packer, D. L., Kowal, R. C., Wheelan, K. R., Irwin, J. M., Champagne, J., Guerra, P. G., Dubuc, M., Reddy, V. Y., Nelson, L., Holcomb, R. G., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.11.064 · Cited by 919
“9% treatment success rate was higher than that predicted by a recent meta-analyses of randomized and observational studies (17) of standard RF ablation, suggesting the potential for simplification of the ablation process by eliminating the need for point-to-point manipulation of the catheter.”
Result
Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device
Biase, L. D., Mohanty, P. K., Mohanty, S., Santangeli, P., Trivedi, C. G., Lakkireddy, D., Reddy, M., Jaı̈s, P., Themistoclakis, S., Russo, A. D., et al. (2016) · Circulation · doi:10.1161/circulationaha.115.019406 · Cited by 880
Materials for multifunctional balloon catheters with capabilities in cardiac electrophysiological mapping and ablation therapy
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Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation
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2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary
Calkins, H. G., Hindricks, G., Cappato, R., Kim, Y., Saad, E., Aguinaga, L., Akar, J. G., Badhwar, V., Brugada, J., Camm, A. J., et al. (2017) · Journal of Arrhythmia · doi:10.1016/j.joa.2017.08.001 · Cited by 709
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Morillo, C. A., Verma, A., Connolly, S. J., Kuck, K. H., Nair, G. M., Champagne, J., Sterns, L. D., Beresh, H., Healey, J. S., Natale, A., et al. (2014) · JAMA · doi:10.1001/jama.2014.467 · Cited by 667
2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation
Tzeis, S. E., Gerstenfeld, E. P., Kalman, J. M., Saad, E., Shamloo, A. S., Andrade, J. G., Barbhaiya, C. R., Baykaner, T., Bovéda, S., Calkins, H. G., et al. (2024) · EP Europace · doi:10.1093/europace/euae043 · Cited by 724
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H. G., Cigarroa, J. E., Cleveland, J. C., CONTI, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.021 · Cited by 581
2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary
Calkins, H. G., Hindricks, G., Cappato, R., Kim, Y., Saad, E., Aguinaga, L., Akar, J. G., Badhwar, V., Brugada, J., Camm, A. J., et al. (2017) · EP Europace · doi:10.1093/europace/eux275 · Cited by 521
Periprocedural Stroke and Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation With Different Anticoagulation Management
Biase, L. D., Burkhardt, J. D., Santangeli, P., Mohanty, P. K., Sánchez, J., Horton, R., Gallinghouse, G. J., Themistoclakis, S., Rossillo, A., Lakkireddy, D., et al. (2014) · Circulation · doi:10.1161/circulationaha.113.006426 · Cited by 485
“Although ablation procedures performed without warfarin discontinuation seem to be associated with lower thromboembolic risk compared with other strategies discontinuing warfarin before ablation, no randomized study currently exists.2–6 This study aims at exploring the risk of periprocedural thromboembolic and hemorrh…”
BackgroundInfluential
2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation
Verma, A., Cairns, J. A., Mitchell, L. B., Macle, L., Stiell, I. G., Gladstone, D. J., McMurtry, M. S., Connolly, S. J., Cox, J. L., Dorian, P., et al. (2014) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2014.08.001 · Cited by 478
Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study)
Mont, L., Bisbal, F., Hernández-Madrid, A., Pérez-Castellano, N., Viñolas, X., Arenal, A., Arribas, F., Fernández-Lozano, I., Bodegas, A., Cobos, A., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/eht457 · Cited by 394
“Long-term ADT is associated with increased risk of adverse events.(9) In the present study, a very low rate of complication was observed in this group.”
BackgroundResult
2011 ACCF/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Update on Dabigatran)
Wann, L. S., Curtis, A. B., Ellenbogen, K. A., Estes, N. A. M., Ezekowitz, M. D., Jackman, W. M., January, C. T., Lowe, J. E., Page, R. L., Slotwiner, D. J., et al. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.01.032 · Cited by 394
Atrial fibrillation in heart failure: what should we do?
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Efficacy and safety of cryoballoon ablation for atrial fibrillation: A systematic review of published studies
Andrade, J. G., Khairy, P., Guerra, P. G., Deyell, M. W., Rivard, L., Macle, L., Thibault, B., Talajic, M. R., Roy, D., & Dubuc, M. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.03.050 · Cited by 360
Atrial fibrillation
Lip, G. Y. H., Tse, H., & Lane, D. A. (2011) · The Lancet · doi:10.1016/s0140-6736(11)61514-6 · Cited by 347
Complications of Catheter Ablation of Atrial Fibrillation
Gupta, A., Perera, T., Ganesan, A. N., Sullivan, T., Lau, D. H., Roberts‐Thomson, K. C., Brooks, A. G., & Sanders, P. (2013) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.113.000768 · Cited by 318
“9%).(6,13) There was also a lower pooled incidence of procedure-related deaths (0.”
BackgroundResult
2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation
Tzeis, S. E., Gerstenfeld, E. P., Kalman, J. M., Saad, E., Shamloo, A. S., Andrade, J. G., Barbhaiya, C. R., Baykaner, T., Bovéda, S., Calkins, H. G., et al. (2024) · Heart Rhythm · doi:10.1016/j.hrthm.2024.03.017 · Cited by 323
Incidence of Silent Cerebral Thromboembolic Lesions After Atrial Fibrillation Ablation May Change According to Technology Used: Comparison of Irrigated Radiofrequency, Multipolar Nonirrigated Catheter and Cryoballoon
Gaïta, F., Leclercq, J. F., Schumacher, B., Scaglione, M., Toso, E., Halimi, F., Schade, A., Froehner, S., Ziegler, V., Sergi, D., et al. (2011) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2011.02050.x · Cited by 290
Evaluating the Atrial Myopathy Underlying Atrial Fibrillation
Goldberger, J. J., Arora, R., Green, D., Greenland, P., Lee, D. C., Lloyd‐Jones, D. M., Markl, M., Ng, J., & Shah, S. J. (2015) · Circulation · doi:10.1161/circulationaha.115.016795 · Cited by 247
Enabling individualized therapy through nanotechnology
Sakamoto, J. H., van de Ven, A. L., Godin, B., Blanco, E., Serda, R. E., Grattoni, A., Žiemys, A., Bouamrani, A., Hu, Y., Ranganathan, S. I., et al. (2010) · Pharmacological Research · doi:10.1016/j.phrs.2009.12.011 · Cited by 234
2011 ACCF/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Updating the 2006 Guideline)
Wann, L. S., Curtis, A. B., January, C. T., Ellenbogen, K. A., Lowe, J. E., Estes, N. A. M., Page, R. L., Ezekowitz, M. D., Slotwiner, D. J., Jackman, W. M., et al. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.10.001 · Cited by 229
2020 Clinical guidelines for Atrial fibrillation and atrial flutter
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2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary
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“J Cardiovasc Electrophysiol 2013;24(8):929–932.”
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The Increasing Role of Rhythm Control in Patients With Atrial Fibrillation
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JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias
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Thoracoscopic Video-Assisted Pulmonary Vein Antrum Isolation, Ganglionated Plexus Ablation, and Periprocedural Confirmation of Ablation Lesions: First Results of a Hybrid Surgical-Electrophysiological Approach for Atrial Fibrillation
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Magnetic control of continuum devices
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“AF can be treated with antiarrhythmic drugs or cardiac ablation, with a combined treatment plan showing the best results (Calkins et al., 2009).”
Background
Radiofrequency ablation vs. antiarrhythmic drug therapy as first line treatment of symptomatic atrial fibrillation: systematic review and meta-analysis
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Pulmonary vein isolation using “contact force” ablation: The effect on dormant conduction and long-term freedom from recurrent atrial fibrillation—A prospective study
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“Although wide circumferential PVI is an established treatment for patients suffering from drug-refractory highly symptomatic AF, a significant minority of patients will require a second intervention because of arrhythmia recurrence.(11,12) Although the persistence of an AF-maintaining reentrant substrate and/or the pr…”
Background
Relationship Between Pulmonary Vein Reconnection and Atrial Fibrillation Recurrence
Nery, P. B., Belliveau, D. J., Nair, G. M., Bernick, J., Redpath, C. J., Szczotka, A., Sadek, M. M., Green, M. S., Wells, G. A., & Birnie, D. H. (2016) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2016.02.003 · Cited by 164
JCS/JHRS 2019 guideline on non‐pharmacotherapy of cardiac arrhythmias
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Predictors of Atrial Fibrillation Recurrence after Catheter Ablation: Data from the German Ablation Registry
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Improving outcomes in patients with atrial fibrillation: rationale and design of the Early treatment of Atrial fibrillation for Stroke prevention Trial
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Catheter ablation of atrial arrhythmias: state of the art
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Cost-Effectiveness of Radiofrequency Catheter Ablation Compared With Antiarrhythmic Drug Therapy for Paroxysmal Atrial Fibrillation
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Rhythm control in atrial fibrillation
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Catheter Ablation of Atrial Fibrillation: An Overview for Clinicians
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“Catheter ablation (CA) is superior to antiarrhythmic drug (AAD) therapy in patients with paroxysmal (PAF) and persistent AF (PeAF) [4].”
Background
Early Recurrence of Atrial Tachyarrhythmias Following Radiofrequency Catheter Ablation of Atrial Fibrillation
Andrade, J. G., Khairy, P., Verma, A., Guerra, P. G., Dubuc, M., Rivard, L., Deyell, M. W., Mondesert, B. A., Thibault, B., Talajic, M. R., et al. (2011) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2011.03256.x · Cited by 141
Does periprocedural anticoagulation management of atrial fibrillation affect the prevalence of silent thromboembolic lesion detected by diffusion cerebral magnetic resonance imaging in patients undergoing radiofrequency atrial fibrillation ablation with open irrigated catheters? Results from a prospective multicenter study
Biase, L. D., Gaïta, F., Toso, E., Santangeli, P., Mohanty, P. K., Rutledge, N., Yan, X., Mohanty, S., Trivedi, C. G., Bai, R., et al. (2014) · Heart Rhythm · doi:10.1016/j.hrthm.2014.03.003 · Cited by 131
“These protocols contained (1) T1 sagittal, (2) DWI axial, (3) flair axial, (4) T2 axial, (5) T1 axial, (6) T2* coronal, and (7) GRE-EPI coronal images as needed to delineate acute lesions within 48 hours compared to preablation scans.”
Magnetic resonance imaging of atrial fibrosis: redefining atrial fibrillation to a syndrome
Gal, P., & MARROUCHE, N. F. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv514 · Cited by 129
“Almost 2 decades later, many changes have been implemented, improving procedure duration and safety, but still not all patients remain free of AF despite isolation of the PVs and suppression of AF triggers.(8,9) Current pathophysiological perspectives suggest AF recurrences are, among others, associated with more exte…”
Cryoballoon Ablation as Initial Treatment for Atrial Fibrillation
Andrade, J. G., Wazni, O. M., Kuniss, M., Hawkins, N. M., Deyell, M. W., Chierchia, G., Nissen, S. E., Verma, A., Wells, G. A., & Turgeon, R. D. (2021) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.06.038 · Cited by 127
Cryoballoon versus RF ablation in paroxysmal atrial fibrillation: results from the German Ablation Registry
SCHMIDT, M., DORWARTH, U., ANDRESEN, D., BRACHMANN, J., KUCK, K., KUNISS, M., LEWALTER, T., SPITZER, S., WILLEMS, S., SENGES, J., et al. (2014) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12267 · Cited by 126
Safety and chronic lesion characterization of pulsed field ablation in a Porcine model
Stewart, M. T., Haines, D. E., Damijan Miklavčič, A., Kos, B., Kirchhof, N., Barka, N., Mattison, L. M., Martien, M., Önal, B., Howard, B. T., et al. (2021) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.14980 · Cited by 127
Gender, Race, and Health Insurance Status in Patients Undergoing Catheter Ablation for Atrial Fibrillation
Patel, N., Deshmukh, A. J., Thakkar, B., Coffey, J. O., Agnihotri, K., Patel, A., Ainani, N., Nalluri, N., Patel, N., Patel, N., et al. (2016) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2016.01.040 · Cited by 124
Quality of life in patients with atrial fibrillation: how to assess it and how to improve it
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“Similarly, catheter ablation has a higher success rate in patients with PAF compared with patients with sustained forms of the arrhythmia.(91)”
Result
Catheter ablation of atrial fibrillation: an update
Haegeli, L., & Calkins, H. G. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu291 · Cited by 123
“In comparison, the success rate for antiarrhythmic drug therapy was 52%.(14) There have been at least 12 prospective, randomized clinical trials”
Background
Holter Monitoring and Loop Recorders: From Research to Clinical Practice
Galli, A., Ambrosini, F., & Lombardi, F. (2016) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2016.17.2 · Cited by 124
MRI Assessment of Ablation‐Induced Scarring in Atrial Fibrillation: Analysis from the DECAAF Study
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Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation
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Integrating new approaches to atrial fibrillation management: the 6th AFNET/EHRA Consensus Conference
Kotecha, D., BREITHARDT, G. E., Camm, A. J., Lip, G. Y. H., Schotten, U., Ahlsson, A., Arnar, D. O., Atar, D., Auricchio, A., Bax, J. J., et al. (2018) · EP Europace · doi:10.1093/europace/eux318 · Cited by 117
Radiofrequency Catheter Ablation and Antiarrhythmic Drug Therapy
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Exercise-based cardiac rehabilitation for adults with atrial fibrillation
Risom, S. S., Zwisler, A., Palm, P., Sibilitz, K. L., Lindschou, J., Gluud, C. N., Taylor, R. S., Svendsen, J. H., & Berg, S. K. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011197.pub2 · Cited by 117
Emerging Technologies for Pulmonary Vein Isolation
Ramirez, F. D., Reddy, V. Y., Viswanathan, R., Hocini, M., & Jaı̈s, P. (2020) · Circulation Research · doi:10.1161/circresaha.120.316402 · Cited by 113
A systematic review of minimally invasive surgical treatment for atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heart epicardial ablation, and the hybrid procedure on safety and efficacy
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PulmOnary vein isolation With vs. without continued antiarrhythmic Drug trEatment in subjects with Recurrent Atrial Fibrillation (POWDER AF): results from a multicentre randomized trial
Duytschaever, M. F., Demolder, A., Phlips, T., Sarkozy, A., Haddad, M. E., Taghji, P., Knecht, S., Tavernier, R., Vandekerckhove, Y. R., & Potter, T. J. R. D. (2017) · European Heart Journal · doi:10.1093/eurheartj/ehx666 · Cited by 113
A review of the cost of atrial fibrillation
Wodchis, W. P., Bhatia, R. S., Leblanc, K., Meshkat, N., & Morra, D. (2012) · Value in Health · doi:10.1016/j.jval.2011.09.009 · Cited by 109
Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation: 5-year outcome in a randomised clinical trial
Nielsen, J. C., Johannessen, A. C., Raatikainen, P. M. J., Hindricks, G., Walfridsson, H., Pehrson, S. M., Englund, A., Hartikainen, J. E. K., Mortensen, L. S., & HANSEN, P. S. (2016) · Heart · doi:10.1136/heartjnl-2016-309781 · Cited by 109
Health Outcomes With Catheter Ablation or Antiarrhythmic Drug Therapy in Atrial Fibrillation
Reynolds, M. R., Gunnarsson, C., Hunter, T. D., Ladapo, J. A., March, J. L., Zhang, M., & Hao, S. C. (2012) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.111.963108 · Cited by 109
Assessing Arrhythmia Burden After Catheter Ablation of Atrial Fibrillation Using an Implantable Loop Recorder: The ABACUS Study
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“Secondary study endpoints comprised “actionable events” that were defined as recordings made by ILR and not CM that resulted in change of clinical care and these included (1) initiation and/or withdrawal of antiarrhythmic drugs or atrioventricular nodal (AVN) blocking agents, (2) cardioversion, (3) discontinuation or…”
MethodResult
Left atrial reservoir function predicts atrial fibrillation recurrence after catheter ablation: a two-dimensional speckle strain study
Mirza, M., Caracciolo, G., Khan, U., Mori, N., Saha, S. K., Srivathsan, K. S., Altemose, G. T., Scott, L. R., Sengupta, P. P., & Jahangir, A. (2011) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-011-9560-6 · Cited by 107
“CA is increasingly used for the management of patients with symptomatic drug refractory AF [10].”
Influential
Left Atrial Deformation Imaging with Ultrasound Based Two‐Dimensional Speckle‐Tracking Predicts the Rate of Recurrence of Paroxysmal and Persistent Atrial Fibrillation After Successful Ablation Procedures
Hammerstingl, C., SCHWEKENDIEK, M., Momčilović, D., Schueler, R., Sinning, J., SCHRICKEL, J. W., Mittmann-Braun, E. L., Nickenig, G., & Lickfett, L. (2011) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2011.02177.x · Cited by 105
The role of myocardial wall thickness in atrial arrhythmogenesis
Whitaker, J., Rajani, R., Chubb, H., Gabrawi, M., Varela, M., Wright, M. J., Niederer, S., & O'Neill, M. D. (2016) · EP Europace · doi:10.1093/europace/euw014 · Cited by 104
2011 ACCF/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Updating the 2006 Guideline)
Wann, L. S., Curtis, A. B., January, C. T., Ellenbogen, K. A., Lowe, J. E., Estes, N. A. M., Page, R. L., Ezekowitz, M. D., Slotwiner, D. J., Jackman, W. M., et al. (2010) · Heart Rhythm · doi:10.1016/j.hrthm.2010.11.047 · Cited by 103
Catheter Cryoablation
Andrade, J. G., Khairy, P., & Dubuc, M. (2013) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.112.973651 · Cited by 104
“However, the procedure is complex, time-consuming, and highly dependent on operator competency.(61) It is subject to inherent difficulties associated with creating contiguous curvilinear lesions using techniques originally developed for discrete ablation.”
BackgroundInfluential
Trends in Hospitalization for Atrial Fibrillation: Epidemiology, Cost, and Implications for the Future
Sheikh, A. B., Patel, N., Nalluri, N., Agnihotri, K., Spagnola, J., Patel, A., Asti, D., Kanotra, R., Khan, H., Savani, C., et al. (2015) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2015.07.002 · Cited by 99
“Studies from a range of high-income countries have examined the overall and direct cost of AF from a health care cost perspective.4,5,47 Several strategies have been utilized to estimate the costs related to AF.”
MethodInfluential
Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: Catheter Ablation for Atrial Fibrillation/Atrial Flutter
Verma, A., Macle, L., Cox, J. L., & Skanes, A. C. (2011) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2010.11.011 · Cited by 99
2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary
Calkins, H. G., Hindricks, G., Cappato, R., Kim, Y., Saad, E., Aguinaga, L., Akar, J. G., Badhwar, V., Brugada, J., Camm, A. J., et al. (2017) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-017-0277-z · Cited by 100
“(8) The incremental role of new technologies: As newer and often more expensive technologies are produced for AF ablation, their definitive incremental value must be determined in order to justify change in practice or case cost.”
Background
Single-Ring Posterior Left Atrial (Box) Isolation Results in a Different Mode of Recurrence Compared With Wide Antral Pulmonary Vein Isolation on Long-Term Follow-Up
Lim, T. W., Koay, C. H., See, V. A., McCall, R., CHIK, W. W. B., Zecchin, R. P., Byth, K., Seow, S., Thomas, L., Ross, D. L., et al. (2012) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.111.970293 · Cited by 99
“SRI Results in Longer AF-Free Survival Studies examining long-term results after pulmonary vein isolation have demonstrated high rates of recurrent arrhythmia after a single procedure.(1,14,15) Weerasooriya et al(1) found that,”
Background
Point‐by‐Point Radiofrequency Ablation Versus the Cryoballoon or a Novel Combined Approach: A Randomized Trial Comparing 3 Methods of Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation (The Cryo Versus RF Trial)
Hunter, R. J., Baker, V., Finlay, M., Duncan, E. R., Lovell, M. J., Tayebjee, M. H., Ullah, W., SIDDIQUI, M. S., McLean, A., Richmond, L., et al. (2015) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12846 · Cited by 95
Monitoring long-term cardiac activity with contactless radio frequency signals
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A proposal for a new scoring system in the prediction of catheter ablation outcomes: Promising results from the Turkish Cryoablation Registry
Canpolat, U., Aytemir, K., Yorgun, H., ŞAHINER, L., Kaya, E. B., & Oto, A. (2013) · International Journal of Cardiology · doi:10.1016/j.ijcard.2013.08.097 · Cited by 92
“It is more effective than antiarrhythmic drug therapy for the maintenance of sinus rhythm in patients with AF, mostly in patients without marked structural heart disease, with a low CHA2DS2-VASc score and with paroxysmal AF [2–4].”
Background
Very long-term outcome after initially successful catheter ablation of atrial fibrillation
Steinberg, J. S., Palekar, R., Sichrovsky, T., Arshad, A., Preminger, M. W., Musat, D. L., Shaw, R. E., & Mittal, S. (2014) · Heart Rhythm · doi:10.1016/j.hrthm.2014.02.003 · Cited by 91
Utility of Esophageal Temperature Monitoring During Pulmonary Vein Isolation for Atrial Fibrillation Using Duty-Cycled Phased Radiofrequency Ablation
Deneke, T., Bünz, K., Bastian, A., Päsler, M., Anders, H., Lehmann, R., MEUSER, W., de Groot, J. R., Horlitz, M., Haberkorn-Butendeich, R., et al. (2010) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2010.01916.x · Cited by 91
Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden. The MANTRA-PAF trial
Walfridsson, H., Walfridsson, U., Nielsen, J. C., Johannessen, A. C., Raatikainen, P. M. J., Janzon, M., Levin, L., Aronsson, M., Hindricks, G., Kongstad, O., et al. (2015) · EP Europace · doi:10.1093/europace/euu342 · Cited by 90
Catheter Ablation for Atrial Fibrillation
Wazni, O. M., Wilkoff, B. L., & Saliba, W. I. (2011) · New England Journal of Medicine · doi:10.1056/nejmct1109977 · Cited by 89

Authors: Calkins, H., Reynolds, M. R., Spector, P., Sondhi, M., Xu, Y., Martin, A., Williams, C. J., & Sledge, I.
Affiliations: University of Vermont (US)
ORCID: Calkins, Hugh
Reynolds, Matthew R.
Spector, Peter
Martin, Amber
Venue: Circulation Arrhythmia and Electrophysiology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2009-08
Volume: 2
Issue: 4
Pages: 349-361
ISSN: 1941-3084 (ISSN-L)
1941-3149
DOI: 10.1161/circep.108.824789
OpenAlex: W2020741490
Cited by: 847
References: 128
Citations by year: 2026: 19 · 2025: 29 · 2024: 42 · 2023: 33 · 2022: 38 · 2021: 48 · 2020: 35 · 2019: 37 · 2018: 43 · 2017: 54 · 2016: 62 · 2015: 63 · 2014: 72 · 2013: 69 · 2012: 74
FWCI: 43.34
Type: journal article
Language: en
Open access: closed
Locations: Circulation Arrhythmia and Electrophysiology (publishedVersion)
PubMed (publishedVersion)
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, amiodarone, dofetilide, sotalol, flecainide, propafenone, treatment efficacy, procedural complications, ablation success rate
MeSH terms: Anti-Arrhythmia Agents, Atrial Fibrillation, Humans, Catheter Ablation

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Treatment of Atrial Fibrillation With Antiarrhythmic Drugs or Radiofrequency Ablation: Two Systematic Literature Reviews and Meta-Analyses

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