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Systematic Review: Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation
Annals of Internal Medicine, 08/12/09

Terasawa T et al. – Radiofrequency catheter ablation is effective for up to 12 months of rhythm control when used as a second–line therapy for atrial fibrillation in relatively young patients with near–intact cardiac function. Longer studies that use primary end points of stroke and mortality are needed.

Methods

MEDLINE and the Cochrane Central Register of Controlled Trials (2000 to December 2008) were searched for English–language reports of studies in adults.
6 independent reviewers screened abstracts to identify longitudinal studies of adults with atrial fibrillation who underwent radiofrequency catheter ablation.
Studies reported arrhythmia or other cardiovascular outcomes at least 6 months after ablation or any adverse events.
Study quality and overall strength of evidence for each question were rated by 2 independent reviewers; disagreements were resolved by consensus.

Results

108 studies met eligibility criteria.
Moderate strength of evidence (3 trials; n = 30 to 198) showed that radiofrequency ablation after a failed drug course was more likely than continuation of drug therapy alone to lead to maintained sinus rhythm.
Low strength of evidence (4 trials [n = 30 to 137] and 1 retrospective study [n = 1171]) suggested that radiofrequency ablation improved quality of life, promoted avoidance of anticoagulation, and decreased readmission rates compared with medical treatment.
Major adverse events occurred in fewer than 5% of patients in most of 84 studies.

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