Abstract 18526: Catheter Ablation as a First-Line Therapy for Atrial Fibrillation - A Meta-Analysis

Introduction: Catheter ablation (CA) has been shown to be superior to anti-arrhythmic therapy (AAD) for drug-refractory atrial fibrillation (AF). Whether CA is superior to AAD as a first-line therapy for AF is not clear. We performed meta-analysis of all prospective studies assessing the efficacy of CA as first line therapy for paroxysmal AF. Methods: We searched PubMed, Cochrane library and Embase for observational studies and randomized control trials (RCT) assessing CA as first-line therapy for AF. Recurrence rates of AF after CA and AADs in these studies were extracted and analyzed. Random effects model with inverse variance weighting was used to calculate relative risk (RR) of AF recurrence after CA in comparison to AADs. Results: We identified 5 prospective trials (3 RCTs and 2 observational) (n=597) of which 3 RCTs compared the efficacy of CA with AADs and the other 2 observational studies evaluated AF recurrence after CA (no comparator group). Follow-up duration ranged from 12 to 24 months across the studies. In these 5 studies, 353 and 244 AF patients received CA and AADs as first line therapy respectively. Pooled data of 353 CA patients revealed AF recurrence rate of 0.28 (95% CI, 0.23 - 0.33). Pooled data of 244 patients who received AADs revealed AF recurrence of 0.44 (95% CI, 0.38 -0.51). Random effects model including the 3 RCTs demonstrated that catheter ablation was associated with a significantly lower AF recurrence rate when compared with AADs (RR: 0.5; 95% CI, 0.28 -0.89; p =0.02). Conclusion: As a first-line therapy strategy for paroxysmal AF, CA is associated with 50% lesser recurrence of AF when compared to AADs.