Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Meta-Analysis of Quality of Life, Morbidity, and Mortality

K.C. Siontis, J.P.A. Ioannidis, G.D. Katritsis, P.A. Noseworthy, D.L. Packer, J.D. Hummel, P. Jais, R. Krittayaphong, L. Mont, C.A. Morillo, J.C. Nielsen, H. Oral, C. Pappone, V. Santinelli, Hemal Weerasooriya, D.J. Wilber, B.J. Gersh, M.E. Josephson, D.G. Katritsis

    Research output: Contribution to journalArticle

    18 Citations (Scopus)

    Abstract

    © 2016 American College of Cardiology Foundation. Objectives The aim of this study was to perform a collaborative meta-analysis of published and unpublished quality-of-life, morbidity, and mortality data from randomized controlled trial comparisons of radiofrequency ablation (RFA) and antiarrhythmic drug therapy (AAD) in symptomatic atrial fibrillation. Background RFA is superior to AAD in decreasing recurrences of atrial fibrillation, but the effects on other clinical outcomes are not well established. Methods The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random-effects summary estimates were calculated as standardized mean differences and risk ratios with 95% confidence intervals for continuous and binary outcomes, respectively. Fixed effects were used in subgroup analyses. Results Twelve randomized controlled trials (n = 1,707 patients) were included. RFA led to greater improvements in 4 36-Item Short Form Health Survey areas and the symptom frequency score from baseline to 3 months. In all quality-of-life metrics, there was a trend toward diminution of the differences between the 2 approaches with follow-up. There were 7 of 866 (5 in a study using phased RFA) and 0 of 704 strokes in the RFA and AAD arms, respectively (p = 0.02, Fisher exact test). Bleeding and mortality events were not significantly different between the 2 arms. There was high heterogeneity for hospitalizations, with decreased hospitalization risk with RFA when it was not first-line therapy (risk ratio: 0.34; 95% confidence interval: 0.24 to 0.46) and increased risk as first-line therapy (risk ratio: 1.22; 95% confidence interval: 1.03 to 1.45). Conclusions RFA demonstrates an early but nonsustained superiority over AAD for the improvement of quality of life. There are no obvious differences in other clinical outcomes, and the periprocedural stroke risk is non-negligible.
    Original languageEnglish
    Pages (from-to)170-180
    Number of pages11
    JournalJACC: Clinical Electrophysiology
    Volume2
    Issue number2
    DOIs
    Publication statusPublished - 2016

    Fingerprint

    Anti-Arrhythmia Agents
    Atrial Fibrillation
    Meta-Analysis
    Quality of Life
    Morbidity
    Drug Therapy
    Randomized Controlled Trials
    Mortality
    Odds Ratio
    Confidence Intervals
    Hospitalization
    Stroke
    Health Surveys
    Research Personnel
    Hemorrhage
    Recurrence
    Therapeutics

    Cite this

    Siontis, K. C., Ioannidis, J. P. A., Katritsis, G. D., Noseworthy, P. A., Packer, D. L., Hummel, J. D., ... Katritsis, D. G. (2016). Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Meta-Analysis of Quality of Life, Morbidity, and Mortality. JACC: Clinical Electrophysiology, 2(2), 170-180. https://doi.org/10.1016/j.jacep.2015.10.003
    Siontis, K.C. ; Ioannidis, J.P.A. ; Katritsis, G.D. ; Noseworthy, P.A. ; Packer, D.L. ; Hummel, J.D. ; Jais, P. ; Krittayaphong, R. ; Mont, L. ; Morillo, C.A. ; Nielsen, J.C. ; Oral, H. ; Pappone, C. ; Santinelli, V. ; Weerasooriya, Hemal ; Wilber, D.J. ; Gersh, B.J. ; Josephson, M.E. ; Katritsis, D.G. / Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Meta-Analysis of Quality of Life, Morbidity, and Mortality. In: JACC: Clinical Electrophysiology. 2016 ; Vol. 2, No. 2. pp. 170-180.
    @article{b9b2b2c0d3024e978d93da99cc66fcd4,
    title = "Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Meta-Analysis of Quality of Life, Morbidity, and Mortality",
    abstract = "{\circledC} 2016 American College of Cardiology Foundation. Objectives The aim of this study was to perform a collaborative meta-analysis of published and unpublished quality-of-life, morbidity, and mortality data from randomized controlled trial comparisons of radiofrequency ablation (RFA) and antiarrhythmic drug therapy (AAD) in symptomatic atrial fibrillation. Background RFA is superior to AAD in decreasing recurrences of atrial fibrillation, but the effects on other clinical outcomes are not well established. Methods The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random-effects summary estimates were calculated as standardized mean differences and risk ratios with 95{\%} confidence intervals for continuous and binary outcomes, respectively. Fixed effects were used in subgroup analyses. Results Twelve randomized controlled trials (n = 1,707 patients) were included. RFA led to greater improvements in 4 36-Item Short Form Health Survey areas and the symptom frequency score from baseline to 3 months. In all quality-of-life metrics, there was a trend toward diminution of the differences between the 2 approaches with follow-up. There were 7 of 866 (5 in a study using phased RFA) and 0 of 704 strokes in the RFA and AAD arms, respectively (p = 0.02, Fisher exact test). Bleeding and mortality events were not significantly different between the 2 arms. There was high heterogeneity for hospitalizations, with decreased hospitalization risk with RFA when it was not first-line therapy (risk ratio: 0.34; 95{\%} confidence interval: 0.24 to 0.46) and increased risk as first-line therapy (risk ratio: 1.22; 95{\%} confidence interval: 1.03 to 1.45). Conclusions RFA demonstrates an early but nonsustained superiority over AAD for the improvement of quality of life. There are no obvious differences in other clinical outcomes, and the periprocedural stroke risk is non-negligible.",
    author = "K.C. Siontis and J.P.A. Ioannidis and G.D. Katritsis and P.A. Noseworthy and D.L. Packer and J.D. Hummel and P. Jais and R. Krittayaphong and L. Mont and C.A. Morillo and J.C. Nielsen and H. Oral and C. Pappone and V. Santinelli and Hemal Weerasooriya and D.J. Wilber and B.J. Gersh and M.E. Josephson and D.G. Katritsis",
    year = "2016",
    doi = "10.1016/j.jacep.2015.10.003",
    language = "English",
    volume = "2",
    pages = "170--180",
    journal = "JACC: Clinical Electrophysiology",
    issn = "2405-500X",
    publisher = "Elsevier",
    number = "2",

    }

    Siontis, KC, Ioannidis, JPA, Katritsis, GD, Noseworthy, PA, Packer, DL, Hummel, JD, Jais, P, Krittayaphong, R, Mont, L, Morillo, CA, Nielsen, JC, Oral, H, Pappone, C, Santinelli, V, Weerasooriya, H, Wilber, DJ, Gersh, BJ, Josephson, ME & Katritsis, DG 2016, 'Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Meta-Analysis of Quality of Life, Morbidity, and Mortality' JACC: Clinical Electrophysiology, vol. 2, no. 2, pp. 170-180. https://doi.org/10.1016/j.jacep.2015.10.003

    Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Meta-Analysis of Quality of Life, Morbidity, and Mortality. / Siontis, K.C.; Ioannidis, J.P.A.; Katritsis, G.D.; Noseworthy, P.A.; Packer, D.L.; Hummel, J.D.; Jais, P.; Krittayaphong, R.; Mont, L.; Morillo, C.A.; Nielsen, J.C.; Oral, H.; Pappone, C.; Santinelli, V.; Weerasooriya, Hemal; Wilber, D.J.; Gersh, B.J.; Josephson, M.E.; Katritsis, D.G.

    In: JACC: Clinical Electrophysiology, Vol. 2, No. 2, 2016, p. 170-180.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Meta-Analysis of Quality of Life, Morbidity, and Mortality

    AU - Siontis, K.C.

    AU - Ioannidis, J.P.A.

    AU - Katritsis, G.D.

    AU - Noseworthy, P.A.

    AU - Packer, D.L.

    AU - Hummel, J.D.

    AU - Jais, P.

    AU - Krittayaphong, R.

    AU - Mont, L.

    AU - Morillo, C.A.

    AU - Nielsen, J.C.

    AU - Oral, H.

    AU - Pappone, C.

    AU - Santinelli, V.

    AU - Weerasooriya, Hemal

    AU - Wilber, D.J.

    AU - Gersh, B.J.

    AU - Josephson, M.E.

    AU - Katritsis, D.G.

    PY - 2016

    Y1 - 2016

    N2 - © 2016 American College of Cardiology Foundation. Objectives The aim of this study was to perform a collaborative meta-analysis of published and unpublished quality-of-life, morbidity, and mortality data from randomized controlled trial comparisons of radiofrequency ablation (RFA) and antiarrhythmic drug therapy (AAD) in symptomatic atrial fibrillation. Background RFA is superior to AAD in decreasing recurrences of atrial fibrillation, but the effects on other clinical outcomes are not well established. Methods The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random-effects summary estimates were calculated as standardized mean differences and risk ratios with 95% confidence intervals for continuous and binary outcomes, respectively. Fixed effects were used in subgroup analyses. Results Twelve randomized controlled trials (n = 1,707 patients) were included. RFA led to greater improvements in 4 36-Item Short Form Health Survey areas and the symptom frequency score from baseline to 3 months. In all quality-of-life metrics, there was a trend toward diminution of the differences between the 2 approaches with follow-up. There were 7 of 866 (5 in a study using phased RFA) and 0 of 704 strokes in the RFA and AAD arms, respectively (p = 0.02, Fisher exact test). Bleeding and mortality events were not significantly different between the 2 arms. There was high heterogeneity for hospitalizations, with decreased hospitalization risk with RFA when it was not first-line therapy (risk ratio: 0.34; 95% confidence interval: 0.24 to 0.46) and increased risk as first-line therapy (risk ratio: 1.22; 95% confidence interval: 1.03 to 1.45). Conclusions RFA demonstrates an early but nonsustained superiority over AAD for the improvement of quality of life. There are no obvious differences in other clinical outcomes, and the periprocedural stroke risk is non-negligible.

    AB - © 2016 American College of Cardiology Foundation. Objectives The aim of this study was to perform a collaborative meta-analysis of published and unpublished quality-of-life, morbidity, and mortality data from randomized controlled trial comparisons of radiofrequency ablation (RFA) and antiarrhythmic drug therapy (AAD) in symptomatic atrial fibrillation. Background RFA is superior to AAD in decreasing recurrences of atrial fibrillation, but the effects on other clinical outcomes are not well established. Methods The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random-effects summary estimates were calculated as standardized mean differences and risk ratios with 95% confidence intervals for continuous and binary outcomes, respectively. Fixed effects were used in subgroup analyses. Results Twelve randomized controlled trials (n = 1,707 patients) were included. RFA led to greater improvements in 4 36-Item Short Form Health Survey areas and the symptom frequency score from baseline to 3 months. In all quality-of-life metrics, there was a trend toward diminution of the differences between the 2 approaches with follow-up. There were 7 of 866 (5 in a study using phased RFA) and 0 of 704 strokes in the RFA and AAD arms, respectively (p = 0.02, Fisher exact test). Bleeding and mortality events were not significantly different between the 2 arms. There was high heterogeneity for hospitalizations, with decreased hospitalization risk with RFA when it was not first-line therapy (risk ratio: 0.34; 95% confidence interval: 0.24 to 0.46) and increased risk as first-line therapy (risk ratio: 1.22; 95% confidence interval: 1.03 to 1.45). Conclusions RFA demonstrates an early but nonsustained superiority over AAD for the improvement of quality of life. There are no obvious differences in other clinical outcomes, and the periprocedural stroke risk is non-negligible.

    U2 - 10.1016/j.jacep.2015.10.003

    DO - 10.1016/j.jacep.2015.10.003

    M3 - Article

    VL - 2

    SP - 170

    EP - 180

    JO - JACC: Clinical Electrophysiology

    JF - JACC: Clinical Electrophysiology

    SN - 2405-500X

    IS - 2

    ER -