Atrial fibrillation: Circumferential Pulmonary-vein Catheter Ablation for treatment
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2004 Dec 2;351(23):2373-83 Clinical Trial (non-controlled, non-randomized)
IN atrial fibrillation, heart failure, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As -
Is good Than
no relevant comparison group in this trial
To restore and maintain sinus rhythm: after 12 months 70% of patients maintained SR. Improve ejection fraction in those patients with heart failure (average of plus 20% at 12 months)
N Engl J Med. 2018 02 01;378(5):417-427 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, heart failure, systolic (reduced ejection fraction), non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Acute
Is better Than
medical therapy (rate or rhythm control)
To reduce at 3 years a composite of all-cause death from or hospitalization for heart failure: 29% ablation VS 45% medical Tt. Significantly fewer patients in the ablation group died from any cause: 13% VS 25.0%
Arch Intern Med. 2008 Mar 24;168(6):581-6 Systematic Review
IN atrial fibrillation, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Chronic
Is better Than
long-term antiarrhythmic drug therapy
To reduce at 1 year recurrence of AF (24.% abalation VS 81.2% antiarrhythmics) and reduce adverse events. No other clinical outcome assessed (mortality? heart failure?)
Ann Intern Med. 2009 Aug 4;151(3):191-202. Epub 2009 Jul 6. Systematic Review
IN atrial fibrillation, non-pharmacological treatment The Use of
catheter ablation, radiofrequency, circumferential pulmonary vein ablation
As Treatment, Chronic
Is better Than
long-term antiarrhythmic drug therapy
To maintain sinus rhythm and possibly (lower strenght of evidence) improve quality of life, promote avoidance of anticoagulation, and decrease hospitalisation.
JAMA. 2005 Jun 1;293(21):2634-40 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, paroxysmal, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Chronic
Is better Than
chronic antiarrhythmic drug therapy
To reduce symptomatic AF recurrence (13% with ablation VS 63% with drugs) and hospitalizations (9% VS 54%). Pulmonary vein stenosis in 6% patients with ablation.
J Am Coll Cardiol. 2006 Dec 5;48(11):2340-7 Randomized Controlled Trial
IN atrial fibrillation, paroxysmal, refractory, non-pharmacological treatment The Use of
catheter ablation, radiofrequency, circumferential pulmonary vein ablation
As Treatment, Chronic
Is better Than
change to another antiarrhythmic drug
To reduce, at 1 year, recurrences of AF: 7% with ablation VS 65% with drugs. Ablation was repeated in 9% patients and 2 severe adverse effects.
N Engl J Med. 2006 Mar 2;354(9):934-41 Randomized Controlled Trial
IN atrial fibrillation, persistent, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Acute
Is better Than
cardioversion and chronic amiodarone
To reduce atrial fibrillation recurrence: 26% with ablation VS 42% amiodarone; and improve symptoms. Complications: atypical atrial flutter.
Eur Heart J. 2006 Jan;27(2):216-21. Epub 2005 Oct 7 Randomized Controlled Trial
IN atrial fibrillation, refractory, non-pharmacological treatment The Use of
catheter ablation, radiofrequency AND and antiarrhythmic drugs (various)
As Treatment, Chronic
Is better Than
antiarrhythmic drug therapy alone (various drugs)
To prevent AF recurrence: 44% with ablation VS 91% without. Three (4.4%) major complications were related to ablation: stroke, pericardial effusion and a phrenic paralysis.