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

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Very long-term outcomes after a single catheter ablation procedure for the treatment of atrial fibrillation—the protective role of antiarrhythmic drug therapy
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“methodological differences between reports [9, 10].”
Background
Geographic and racial representation and reported success rates of studies of catheter ablation for atrial fibrillation: Findings from the SMASH‐AF meta‐analysis study cohort
Leef, G. C., Perino, A. C., Cluckey, A., Yunus, F. N., Askari, M., Heidenreich, P. A., Narayan, S. M., Wang, P. J., & Turakhia, M. P. (2018) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.13439 · Cited by 14
Safety and Effectiveness of a Next-Generation Contact Force Catheter
Lo, M. Y., Sanders, P., Sommer, P., Kalman, J. M., Siddiqui, U., Sundaram, S., Piorkowski, C., Olson, N., Madej, S., & Gibson, D. N. (2021) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2021.01.019 · Cited by 14
Comparative Safety of Pulsed Field Ablation and Cryoballoon Ablation Technologies for Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation: A Critical Literature Review and Indirect Treatment Comparison
Maccioni, S., Sharma, R., Lee, D. D., Haltner, A., Khanna, R., & Vijgen, J. M. (2024) · Advances in Therapy · doi:10.1007/s12325-023-02765-x · Cited by 12
The Hot and the Cold: Radiofrequency Versus Cryoballoon Ablation for Atrial Fibrillation
Ang, R., Domenichini, G., Finlay, M., SCHILLING, R. J., & Hunter, R. J. (2015) · Current Cardiology Reports · doi:10.1007/s11886-015-0631-7 · Cited by 13
From European to National guidelines on heart disease
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Catheter Ablation for Atrial Fibrillation in Patients with Chronic Kidney Disease and on Dialysis: A Meta-Analysis and Review
Chung, I., Khan, Y. M. A., Warrens, H., Seshasai, R. K., Sohal, M., & Banerjee, D. (2022) · Cardiorenal Medicine · doi:10.1159/000525388 · Cited by 13
Radiofrequency hot balloon catheter ablation for the treatment of atrial fibrillation: A 3‐center study in Japan
Sohara, H., Satake, S., Takeda, H., Yamaguchi, Y., Toyama, H., Kumagai, K., Kuwahara, T., Takahashi, A., & Ohe, T. (2012) · Journal of Arrhythmia · doi:10.1016/j.joa.2012.07.005 · Cited by 13
Silent Cerebral Embolism during Atrial Fibrillation Ablation:Pathophysiology, Prevention and Management.
Anselmino, M., Matta, M., Toso, E., Ferraris, F., Castagno, D., Scaglione, M., Cesarani, F., Faletti, R., & Gaïta, F. (2013) · Europe PMC (PubMed Central) · doi:10.4022/jafib.796 · Cited by 13
RETRACTED: Prediction of arrhythmia recurrence after atrial fibrillation ablation in patients with normal anatomy of the left atrium
Baimbetov, A. K., Bizhanov, K. A., Аbzaliyev, K., Bairamov, B. A., & Yakupova, I. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14083 · Cited by 13
Retracted
Association between weight loss and outcomes in patients undergoing atrial fibrillation ablation: a systematic review and dose–response meta-analysis
Zhao, H., Li, X., Yu, P., Liu, M., Ma, J., Wang, J., Zhu, W., & Liu, X. (2023) · Nutrition & Metabolism · doi:10.1186/s12986-023-00724-5 · Cited by 12
“Catheter ablation of AF is a recognized treatment method to prevent recurrence of AF, especially for drugrefractory symptomatic AF [6].”
Background
Insights into the Role of Galectin-3 as a Diagnostic and Prognostic Biomarker of Atrial Fibrillation
Kia, Y. M., Cannavò, A., Bahiraie, P., Alilou, S., Saeedian, B., Babajani, N., Ghondaghsaz, E., Khalaji, A., & Behnoush, A. H. (2023) · Disease Markers · doi:10.1155/2023/2097012 · Cited by 13
The relation between oxidative stress biomarkers and atrial fibrillation after pulmonary veins isolation
Böhm, A., Tóthová, Ľ., Urban, L., Slezak, P. P., Bachárová, L., Musil, P., & Hatala, R. (2016) · Journal of Electrocardiology · doi:10.1016/j.jelectrocard.2016.03.007 · Cited by 12
“[9,10].”
Uninterrupted administration of edoxaban vs vitamin K antagonists in patients undergoing atrial fibrillation catheter ablation: Rationale and design of the ELIMINATE‐AF study.
Hohnloser, S. H., Camm, A. J., Cappato, R., Diener, H., Heidbüchel, H., Lanz, H., Mont, L., Morillo, C. A., Smolnik, R., Yin, O. Q. P., et al. (2018) · Clinical Cardiology · doi:10.1002/clc.22918 · Cited by 12
Inducibility of atrial fibrillation after catheter ablation predicts recurrences of atrial fibrillation: a meta‐analysis
Millenaar, D., Becker, N., Pavlicek, V., Wintrich, J., Böhm, M., Mahfoud, F., & Ukena, C. (2021) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.14216 · Cited by 11
“total number of patients, (2) number of patients with inducible AF, and (3) number ofAF recurrences in this group, (4) number of patientswithout inducible AF, and (5) number of AF recurrences in this group, (6) type of AF: paroxysmal versus persistent versus both, (7) use of isoproterenol: yes versu no, (8) stimulatio…”
Background
Outcomes of catheter ablation versus antiarrhythmic therapy in patients with atrial fibrillation: a systematic review and meta-analysis
Deshpande, R., Al‐Khadra, Y., SINGANALLUR, P. M., Botchway, A., & Labedi, M. R. (2022) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-022-01365-z · Cited by 13
Surface ECG f Wave Analysis of Dofetilide Drug Effect in the Atrium
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Rhythm Control for Management of Patients With Atrial Fibrillation: Balancing the Use of Antiarrhythmic Drugs and Catheter Ablation
Viles-González, J. F., Fuster, V., Halperin, J. L., Calkins, H. G., & Reddy, V. Y. (2011) · Clinical Cardiology · doi:10.1002/clc.20857 · Cited by 12
New treatment options for atrial fibrillation: towards patient tailored therapy
Smit, M. D., & Gelder, I. C. V. (2011) · Heart · doi:10.1136/heartjnl-2011-300276 · Cited by 12
Radiofrequency Ablation for Treatment of Atrial Fibrillation
Safaei, N., Montazerghaem, H., Azarfarin, R., Alizadehasl, A., & Alikhah, H. (2011) · Europe PMC (PubMed Central) · doi:10.5681/bi.2011.023 · Cited by 12
“Studies of RFCA for treatment of AF report higher efficacy rates than do studies of AAD therapy and a lower rate of complications (Calkins et al. 2009).”
Background
Pharmacological therapy following catheter ablation of atrial fibrillation
Rordorf, R., Savastano, S., Gandolfi, E., Vicentini, A., Petracci, B., & Landolina, M. (2011) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0b013e32834d5880 · Cited by 12
Cardiac Lesion Mapping In Vivo Using Intracardiac Myocardial Elastography
Bunting, E., Papadacci, C., Wan, E. Y., Sayseng, V., Grondin, J., & Konofagou, E. E. (2017) · IEEE Transactions on Ultrasonics Ferroelectrics and Frequency Control · doi:10.1109/tuffc.2017.2768301 · Cited by 12
“2768301 been reported in the range of 53%–57% for a single procedure and 71%–80% after multiple procedures [1], [2].”
Convergent ablation for persistent atrial fibrillation: Single center experience
Gulkarov, I. M., Wong, B. C., Kowalski, M., Worku, B., Afzal, A., Ivanov, A. V., Ramasubbu, K., & Reddy, B. (2019) · Journal of Cardiac Surgery · doi:10.1111/jocs.14204 · Cited by 12
Stereotactic Radiotherapy Ablation and Atrial Fibrillation: Technical Issues and Clinical Expectations Derived From a Systematic Review
Franzetti, J., Volpe, S., Catto, V., Conte, E., Piccolo, C., Pepa, M., Piperno, G., Camarda, A. M., Cattani, F., Andreini, D., et al. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.849201 · Cited by 12
Pulsed Field Ablation Versus Sham to Treat Atrial Fibrillation: The PFA-SHAM Randomized Clinical Trial
Osmancik, P. P., Neužil, P., Hozmanová, J., Petrů, J., Heřman, D., Královec, Š., Hozman, M., Tichý, M., Waldauf, P., Karel, T., et al. (2026) · Circulation · doi:10.1161/circulationaha.126.079484 · Cited by 11
Initial experience and treatment of atrial fibrillation using a novel irrigated multielectrode catheter: Results from a prospective two‐center study
Rodríguez‐Entem, F., Expósito, V., Rodríguez‐Mañero, M., González‐Enríquez, S., Fernández‐López, X. A., García‐Seara, J., Martínez‐Sande, J. L., & Olalla, J. J. (2015) · Journal of Arrhythmia · doi:10.1016/j.joa.2015.09.011 · Cited by 11
“The acute success rate was similar or even superior to that obtained using standard RF ablation with the point-by-point approach [7].”
Result
Totally Thoracoscopic Surgical Ablation or Catheter Ablation of Atrial Fibrillation
Edgerton, J. R., Philpot, L. M., Falley, B., & Barnes, S. A. (2012) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2012.05.001 · Cited by 11
WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation
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.2017.07.001 · Cited by 11
A self-management support intervention for patients with atrial fibrillation: a randomized controlled pilot trial
Jobst, S., Leppla, L., & Köberich, S. (2020) · Pilot and Feasibility Studies · doi:10.1186/s40814-020-00624-y · Cited by 14
Prevalence and predictors of left atrial thrombosis in atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants
Angelini, F., Bocchino, P. P., Peyracchia, M., Saglietto, A., Magnano, M., Patanè, N., D’Ascenzo, F., Giustetto, C., Anselmino, M., Gaïta, F., et al. (2021) · Acta cardiologica. Supplementum · doi:10.1080/00015385.2021.2005307 · Cited by 11
Lone Atrial Fibrillation: Where Are We Now?
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Role of three-dimensional imaging integration in atrial fibrillation ablation
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Electrical Isolation of Pulmonary Veins Using Laser Catheter in the Treatment of Paroxysmal and Persistent Atrial Fibrillation. One-year Results
Osca, J., Andrés, A., Cano, Ó., Alonso, P., Tello, M. J. S., Olagüe, J., Martínez‐Dolz, L., & Salvador, A. (2015) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2015.08.022 · Cited by 11
“9 [1-23] 4 5 7 6”
Ipsilateral Circumferential Radiofrequency Ablation of Atrial Fibrillation With Irrigated Tip Catheter
Wójcik, M., Erkapic, D., Berkowitsch, A., Zaltsberg, S., Greiß, H., Schmitt, J., Pajitnev, D., Lehinant, S., Rixe, J., Hamm, C. W., et al. (2013) · Circulation Journal · doi:10.1253/circj.cj-13-0275 · Cited by 11
Effective contact and outcome after pulmonary vein isolation in novel circular multi-electrode atrial fibrillation ablation
Gal, P., Buist, T. J., Smit, J. J. J., Adıyaman, A., Misier, A. R. R., Delnoy, P. P. H. M., & Elvan, A. (2016) · Netherlands Heart Journal · doi:10.1007/s12471-016-0907-6 · Cited by 11
“Although PVI has proven to be an effective treatment for AF, some patients develop recurrences [3, 15].”
Background
Trends and predictors of early ablation for Atrial Fibrillation in a Nationwide population under age 65: a retrospective observational study
D’Angelo, R. N., Khanna, R., Yeh, R. W., Goldstein, L. J., Kalsekar, I. D., Marcello, S. R., Tung, P., & ZIMETBAUM, P. J. (2020) · BMC Cardiovascular Disorders · doi:10.1186/s12872-020-01446-9 · Cited by 12
Catheter ablation superiority over the pharmacological treatments in atrial fibrillation: a dedicated review
Alrumayh, A., & Alobaida, M. (2021) · Annals of Medicine · doi:10.1080/07853890.2021.1905873 · Cited by 11
Association of SCN10A Polymorphisms with the Recurrence of Atrial Fibrillation after Catheter Ablation in a Chinese Han Population
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Scar Homogenization in Atrial Fibrillation Ablation: Evolution and Practice
Saini, A., Huizar, J. F., Tan, A. Y., Koneru, J. N., Ellenbogen, K. A., & Kaszala, K. (2017) · Journal of Atrial Fibrillation · doi:10.4022/jafib.1645 · Cited by 11
Apixaban is Dear to Me, but Dearer Still is Warfarin
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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., Taylor, R. S., Gluud, C. N., Svendsen, J. H., & Berg, S. K. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011197 · Cited by 11
Thoracoscopic Surgical Ablation of Lone Atrial Fibrillation: Long-term Outcomes at 7 Years
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Impact of frailty in patients with non‐valvular atrial fibrillation undergoing catheter ablation
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Long-term clinical outcome of patients who failed catheter ablation of atrial fibrillation
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Granger Causality and Jensen–Shannon Divergence to Determine Dominant Atrial Area in Atrial Fibrillation
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“Pulmonary vein catheter ablation is a widely used procedure that isolates the pulmonary veins from the rest of the heart and prevents any pulses from these veins from getting into the heart, restoring normal rhythm in patients with AF [41].”
Background
Atrial mapping during pulmonary vein pacing to detect conduction gaps in a second pulmonary vein isolation procedure
Barrio-López, M. T., Castellanos, E., Ortiz, M., Arceluz, M. R., Lázaro, C., Salas, J., Madero, S., & Almendral, J. M. (2018) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-018-0371-x · Cited by 10
“After the first ablation procedure, up to 30% of the patients present AF recurrences [2], mainly due to PV reconnections [3].”
Background
Towards Early Detection and Burden Estimation of Atrial Fibrillation in an Ambulatory Free-living Environment
Zhang, H., Zhu, L., Nathan, V., Kuang, J., Kim, J., Gao, J. A., & Olgin, J. E. (2021) · Proceedings of the ACM on Interactive Mobile Wearable and Ubiquitous Technologies · doi:10.1145/3463503 · Cited by 14
Machine Learning Methodologies for Prediction of Rhythm-Control Strategy in Patients Diagnosed With Atrial Fibrillation: Observational, Retrospective, Case-Control Study
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“As such, the treatment of AF beyond identification of individuals needing anticoagulation is generally directed toward one of two strategies: (1) a rate-control strategy, focused solely on reducing the rate of ventricular excitation without attempting to restore sinus rhythm, or (2) a rhythm-control strategy, in which…”
Method
Transesophageal Echocardiography-Guided Transseptal Left Atrial Access to Improve Safety in Patients Undergoing Pulmonary Vein Isolation
Zuercher, R., Herling, A., Schmidt, M. T., Bachmann, M., Winnik, S. H., Duru, F., & Eriksson, U. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11092546 · Cited by 10

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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