Efficacy and safety of different forms of ablation therapies and antiarrhythmic drugs in atrial fibrillation: a systematic review and network meta-analysis of randomized clinical trials.

BACKGROUND

This Bayesian network meta-analysis (NMA) was conducted to compare the efficacy and safety of ablations and antiarrhythmic drugs (AADs) to determine the optimal treatment choice for atrial fibrillation (AF).

METHODS

We searched PubMed, Embase, Web of Science, and Cochrane Library from their inception to December 15, 2024, for relevant randomized controlled trials (RCTs). The risk of bias assessment tool developed by the Cochrane Collaboration Network was utilized to evaluate the risk of bias. The main outcomes were AF recurrence, adverse events, and all-cause death. A Bayesian NMA was conducted based on the collected data.

RESULTS

In total, 65 RCTs (n=17,770) comparing four ablations [cryoablation (CBA), laser balloon ablation (LBA), radiofrequency ablation (RFA), surgical ablation (SA)] and AADs were included. In this NMA, the four ablations all significantly reduced the risk of recurrent AF compared with AADs, with no significant differences [RFA: risk ratio (RR) =0.503, 95% confidence interval (CI): 0.423-0.594; CBA: RR =0.465, 95% CI: 0.370-0.579; LBA: RR =0.522, 95% CI: 0.306-0.891; SA: RR =0.664, 95% CI: 0.392-1.12]. CBA and SA groups may be associated with more adverse events than AAD groups (CBA: RR =1.462, 95% CI: 0.956-2.283; SA: RR =2.054, 95% CI: 0.999-4.369). RFA appeared to reduce all-cause mortality compared to AADs (RR =0.745, 95% CI: 0.552-1.014). CBA took the shortest time to complete compared to the other three ablations.

CONCLUSIONS

Catheter ablation (CA) and SA are equally effective and superior to AADs. However, SA has a high risk of complications, while compared with AADs, no evidence indicates that RFA and SA significantly reduce the risk of mortality.