Efficacy of Catheter Ablation for Persistent Atrial Fibrillation: A Systematic Review and Meta-Analysis of Evidence From Randomized and Nonrandomized Controlled Trials
Abstract
BACKGROUND: Catheter ablation (CA) is commonly performed for persistent atrial fibrillation, but few high-quality randomized controlled trials (RCTs) exist, leading to funding restrictions being proposed in several countries. We performed a random-effects meta-analysis of RCTs and non-RCTs to assess the efficacy of CA for persistent atrial fibrillation. METHODS AND RESULTS: We systematically searched PubMed, EMBASE, CENTRAL, OpenGrey, and clinicaltrials.gov for RCTs and non-RCTs reporting clinical outcomes after CA for persistent atrial fibrillation. Forty-six eligible studies were identified containing 3819 patients. After a single procedure, CA significantly reduced the risk of recurrent atrial fibrillation compared with medical therapy (odds ratio [OR], 0.32; 95% confidence interval [CI], 0.20-0.53; P<0.001). Outcomes were better if the pulmonary veins were encircled (OR, 0.26; 95% CI, 0.09-0.74; P=0.01), and electrical isolation reduced AF recurrence compared with purely anatomic encirclement (OR, 0.33; 95% CI, 0.13-0.86; P=0.02). Linear ablation within the left atrium (OR, 0.22; 95% CI, 0.10-0.49; P<0.001), but not complex fractionated atrial electrogram ablation (OR, 0.64; 95% CI, 0.35-1.18; P=0.15), significantly reduced AF recurrence. Results were not improved by performing more extensive linear lesion sets (OR, 0.77; 95% CI, 0.41-1.43; P=0.40) or from biatrial ablation (OR, 0.62; 95% CI, 0.31-1.24; P=0.17). Where data were available, the relative benefits seen held true both after a single or multiple procedure(s). Sensitivity analyses showed that inclusion of non-RCTs increased statistical power without biasing the calculated effect sizes. CONCLUSIONS: For patients with persistent atrial fibrillation, CA achieves significantly greater freedom from recurrent atrial fibrillation compared with medical therapy. The most efficacious strategy is likely to combine isolation of the pulmonary veins with limited linear ablation within the left atrium.
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Catheter ablation is more effective than antiarrhythmic drug therapy in maintaining sinus rhythm.
“Catheter ablation is more effective than antiarrhythmic drug therapy in maintaining sinus rhythm (Web Addenda Figure 2).746,1039”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [746]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- Wynn, G. J., Das, M., Bonnett, L. J., Panikker, S., Wong, T., & Gupta, D.
- Affiliations
- University of Liverpool (GB)
- Venue
- Circulation Arrhythmia and Electrophysiology
- Published
- 2014-10
- Volume
- 7
- Issue
- 5
- Pages
- 841-852
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2150808288
- Cited by
- 146
- References
- 69
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 9 · 2023: 9 · 2022: 6 · 2021: 4 · 2020: 8 · 2019: 21 · 2018: 12 · 2017: 23 · 2016: 29 · 2015: 17 · 2014: 1
- FWCI
- 16.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Boston Scientific Corporation
- Biosense Webster
- 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
- catheter ablation, persistent atrial fibrillation, atrial fibrillation recurrence, pulmonary vein isolation, linear ablation, biatrial ablation, treatment comparison, left atrium, treatment efficacy
- MeSH terms
- Anti-Arrhythmia Agents, Atrial Fibrillation, Heart Atria, Humans, Pulmonary Veins, Recurrence, Risk Factors, Time Factors, Odds Ratio, Randomized Controlled Trials as Topic, Treatment Outcome, Catheter Ablation, Disease-Free Survival
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