TY - JOUR
T1 - Persistent atrial fibrillation
T2 - A systematic review and meta-analysis of invasive strategies
AU - Berger, Wouter R
AU - Meulendijks, Eva R
AU - Limpens, Jacqueline
AU - van den Berg, Nicoline W E
AU - Neefs, Jolien
AU - Driessen, Antoine H G
AU - Krul, Sébastien P J
AU - van Boven, Wim Jan P
AU - de Groot, Joris R
N1 - Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - 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.
AB - 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.
KW - Atrial Fibrillation/diagnosis
KW - Catheter Ablation/adverse effects
KW - Humans
KW - Minimally Invasive Surgical Procedures/adverse effects
KW - Postoperative Complications/diagnosis
KW - Randomized Controlled Trials as Topic/methods
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85058401889&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85058401889&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30553497
U2 - https://doi.org/10.1016/j.ijcard.2018.11.127
DO - https://doi.org/10.1016/j.ijcard.2018.11.127
M3 - Article
C2 - 30553497
SN - 0167-5273
VL - 278
SP - 137
EP - 143
JO - International journal of cardiology
JF - International journal of cardiology
ER -