Efficacy of ablation therapy on clinical outcomes in patients with atrial fibrillation: a systematic review and meta-analysis

Background: Optimal treatment regimen for patients with atrial fibrillation (AF) remains unclear. Therefore, the authors sought to compare the outcomes of ablation therapy versus pharmacological regimens in patients with AF. Methods: MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials and observational studies comparing clinical outcomes between of ablation and pharmacological therapy in patients with AF. Stroke, all-cause mortality, cardiovascular mortality, cardiovascular hospitalization, heart failure (HF), and bleeding were among outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95 % CIs. Results: The analysis included similar to 200 000 patients from 4 randomized controlled trials and 7 observational studies. Meta-analysis showed statistically significant reduction in stroke among patients on ablation therapy [hazard ratio (HR) 0.51, 95% CI (0.43, 0.60), P < 0.00001, I-2 = 10%], all-cause mortality [HR 0.64, 95% CI (0.45, 0.93), P = 0.02, I-2 = 58%], cardiovascular mortality [HR 0.35, 95% CI (0.25, 0.50), P < 0.0001, I-2 = 0%], and HF [HR 0.40, 95% CI (0.31, 0.53), P < 0.00001, I-2 = 30%]. However, no significant difference was revealed in the risk of cardiovascular hospitalization [HR 1.04, 95% CI (0.88, 1.23), P = 0.66, I-2 = 89%] and bleeding [HR 1.11, 95% CI (0.97, 1.27), P = 0.13, I-2 = 0%]. Conclusion: Ablation significantly reduces the risk of stroke, cardiovascular mortality, all-cause mortality, and HF in AF patients, with medical alone, its use in clinical