Persistent atrial fibrillation: A systematic review and meta-analysis of invasive strategies

Wouter R Berger, Eva R Meulendijks, Jacqueline Limpens, Nicoline W E van den Berg, Jolien Neefs, Antoine H G Driessen, Sébastien P J Krul, Wim Jan P van Boven, Joris R de Groot

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43 Citations (Scopus)


BACKGROUND: Persistent atrial fibrillation (AF) is associated with higher stroke and mortality risk than paroxysmal AF (pAF). Outcomes of catheter or surgical ablation are worse in patients with persistent AF than in pAF, and the optimal invasive rhythm control strategy has not been established.

PURPOSE: We provide a contemporary systematic overview on efficacy and safety of catheter and minimally-invasive surgical ablation for persistent AF.

METHODS: We systematically searched EMBASE, MEDLINE and CENTRAL from inception to July 2018 for randomized trials on surgical and catheter ablation, and included all study arms on persistent AF. Outcome was AF freedom after ≥12 months follow-up without AAD use. Random effects models were used to calculate proportions with 95%-confidence intervals. Safety consisted of adverse events during treatment and follow-up.

RESULTS: We included 6 studies on minimally-invasive surgical ablation and 56 on catheter ablation, involving 7624 patients with persistent AF. AF Freedom at 12 months was 69% (95%CI 64-74%) after surgical and 51% (95%CI 46-56%) after catheter ablation. More severe procedural adverse events occurred with surgery than with catheter ablation.

CONCLUSIONS: In persistent AF patients, minimally-invasive surgical ablation is associated with more procedural complications, but higher AF freedom. As adverse events after surgical ablation appear more severe than in catheter ablation, a patient-tailored therapy choice is warranted.

Original languageEnglish
Pages (from-to)137-143
Number of pages7
JournalInternational journal of cardiology
Publication statusPublished - 1 Mar 2019


  • Atrial Fibrillation/diagnosis
  • Catheter Ablation/adverse effects
  • Humans
  • Minimally Invasive Surgical Procedures/adverse effects
  • Postoperative Complications/diagnosis
  • Randomized Controlled Trials as Topic/methods
  • Treatment Outcome

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