Cryoablation versus antiarrhythmic therapy for initial treatment of atrial fibrillation: a systematic review and meta-analysis. (3rd July 2021)

• Record Type: Journal Article
• Authors: Patel, Mitra; Changal, Khalid; Patel, Neha; Elzanaty, Ahmed
• Is Part Of: Expert review of cardiovascular therapy. Volume 19:Number 7(2021)
• Page Start: 667
• Page End: 671
• Publication Date: 2021-07-03
• Subjects: Atrial fibrillation -- cryoablation -- antiarrhythmic -- electrophysiology -- electrocardiogram; Cardiovascular agents -- Research -- Periodicals; 616.12061
• DOI: 10.1080/14779072.2021.1941875
• Languages: English
• ISSNs: 1477-9072

Abstract

ABSTRACT: Background: Atrial fibrillation is a common cardiac arrhythmia that affects approximately 2% of the overall population. Current guidelines suggest the use of antiarrhythmic agents as initial therapy in patients with symptomatic atrial fibrillation; however, using cryoablation as a first-line therapy might provide increased efficacy. Methods: We conducted a systematic review from inception to March 2021 to find randomized controlled trials (RCT) that directly compared cryoablation therapy versus antiarrhythmic therapy as initial treatment for atrial fibrillation. Results: The primary outcome of our meta-analysis was recurrence of atrial arrhythmias. The secondary outcome evaluated serious adverse events of each therapy. Three RCTs involving 724 patients were included in the meta-analysis. The results showed a statistically significant reduction in recurrence of atrial arrhythmias in patients receiving cryoablation compared to antiarrhythmic therapy [RR 0.60, 95% CI (0.50, 0.72), P < 0.00001, I 2 = 0%]. There was no significant difference in serious adverse events between patients receiving cryoablation compared to patients receiving antiarrhythmic therapy [RR 0.80, 95% CI (0.57, 1.13), P = 0.21, I 2 = 0%]. Conclusion: Our meta-analysis showed that cryoablation therapy as initial therapy is more efficacious than antiarrhythmic therapy in patients with atrial fibrillation without an increased risk of serious adverse events.