Catheter vs thoracoscopic ablation for atrial fibrillation: Meta-analysis of randomized trials

Background: We meta-analyzed the efficacy and safety of catheter (CA) vs thoracoscopic (TA) ablation for atrial fibrillation (AF). Methods: PubMed, Embase, and Cochrane databases were searched until 31/12/2019 for relevant randomized trials and subsequent pooled analyses. Results: In six trials totaling 465 patients (254 CA/211 TA), 1-year AF recurrences were higher for CA (46% vs 26%, odds ratio 2.90 [95% CI 1.32-6.38]), whereas total adverse events were lower (10% vs 25%, 0.35 [0.14-0.86], respectively). Conclusion: CA has lower efficacy but higher safety than TA. CA should remain the first-line AF ablation strategy, and TA reserved for selected CA-resistant patients where rhythm control is clinically necessary.