Safety of catheter ablation compared with antiarrhythmic drugs for atrial fibrillation: A systematic review and meta-analysis of randomized trials.

BACKGROUND

Catheter ablation (CA) is superior to antiarrhythmic drugs (AADs) for maintaining sinus rhythm in atrial fibrillation (AF). However, most randomized controlled trials lack the power to assess CA safety.

OBJECTIVE

This study aimed to evaluate complication rates and relative risks of CA compared with AADs for AF rhythm management.

METHODS

MEDLINE, Embase, and Cochrane CENTRAL (from inception to October 24, 2024) were searched for randomized controlled trials comparing CA with AADs in AF management. The primary endpoint was a composite of serious adverse events (SAEs), including death, additional intervention, prolonged or unplanned hospitalization or disability. Secondary endpoints included SAE components. A random-effects meta-analysis estimated pooled risk ratios (RRs) with 95% confidence intervals (CIs).

RESULTS

24 randomized trials comprising 6665 participants were included in the meta-analysis, with 3554 patients (53.2%) assigned to the CA group and 3111 patients (46.7%) to the AAD group. During a 12-month median follow-up (6-60 months), CA was associated with a 20% lower risk of SAE than AAD (RR 0.80, 95% CI 0.69-0.93, I2 0%, P < .01) and 47% reduction in risk unplanned hospitalization (RR 0.53, 95% CI 0.38-0.72, I2 73%, P < .01). CA was also associated with a 37% lower risk of adverse cardiovascular events (RR 0.63, 95% CI 0.44-0.90, I2 42%, P = .01).

CONCLUSION

CA for AF rhythm management reduced SAEs, unplanned hospitalization and adverse cardiovascular events compared with AADs. When patient safety is being considered, AAD appears to have a less favorable safety profile than CA in AF.