Long-Term Outcomes and Improvements in Quality of Life in Patients with Atrial Fibrillation Treated with Catheter Ablation vs. Antiarrhythmic Drugs

Abstract

Objectives: Although catheter ablation (CA) has been recognized as first-line treatment in selected patients with atrial fibrillation (AF), the difference in long-term outcomes and improvements in quality of Life between treatment of AF after CA and antiarrhythmic drugs (AADs) has been few summarized. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the clinical outcomes of differences in long-term outcomes and improvements in quality of Life (QoL) between treatment with CA and AADs for AF.

Methods: We performed a search of published reports by using MEDLINE database (January 1, 2005 to March 20, 2019) with no restrictions. The Randomized Controlled Trials (RCTs) that reported sample size and occurrence numbers of long-term outcomes as well as sample size, mean and standard deviation (SD) or 95% confidence interval (CI) of QoL in CA group and AADs group for the associations of interest were included.

Results: Twenty RCTs involving 5,425 participants were identified. In long-term outcomes, compared with those who receiving AADs therapy, patients receiving CA of AF showed a significant decrease of the risk of all-cause death (RR 0.72, 95% CI 0.58-0.90) as well as cardiovascular hospitalization (RR 0.85, 95% CI 0.79-0.91), and a significant increase of the risk of tamponade (RR 5.86, 95% CI 1.77-19.44), while no difference between CA and AADs therapy in the risk of heart failure, stroke or TIA, atrial tachycardia, bleeding or hematoma, and pulmonary vein stenosis. For long-term QoL, both CA and AADs therapy showed the improvement of the scores of AF patients' physical component summary (PCS) (CA: WMD 5.89; AADs: WMD 4.26), mental component summary (MCS) (CA: WMD 7.12; AADs: WMD 5.06). While at the end of follow-up, CA groups showed significant higher scores of PCS and MCS than those of AADs groups. The change of scores of PCS and MCS between baseline and end of follow-up in CA groups is also significantly higher than those in AADs groups (PCS: WMD 1.51; MCS: WMD 1.49). For 36-item short-form health survey (SF-36) subscales, CA showed the improvement of the scores of AF patients' all of eight subscale scores while AADs showed the improvement of the scores of PF, RP, VT, SF, RE and MH. At the end of follow-up, CA groups showed significant higher scores of PF, RP, BP, GH, VT and RE than those of AADs groups.

Conclusions: CA of AF appeared to be superior to AADs in decreasing the risk of all-cause death and cardiovascular hospitalization, and in improving AF patients' long-term QoL. CA could be seen as a more effective and relatively safe treatment strategy than AADs therapy with escaping from antiarrhythmic drug-specific complications and side effects.

Funding Statement: This work was supported by National Natural Science Foundation of China (No. 81370285), and Guangzhou City Science and Technology Program (No. 201508020057) to Dr. Wu.

Declaration of Interests: The authors state: "None."

Ethics Approval Statement: The meta-analysis was conducted following the PRISMA guidelines.

Keywords: Long-term outcomes; Quality of Life; Catheter Ablation; Antiarrhythmic Drug; Meta-analysis