Mechanism

catheter ablation

Catheter ablation

atrial fibrillation, in all type of patients

death or hospitalization for cardiac causes by 17% suggested

Atrial fibrillation recurrence by 47% suggested

atrial tachyarrhythmia recurrence free survival by 253% suggested

Freedom from arrhythmia at 12 months per protocol by 299% suggested

freedom from arrhythmia at 12 months - worst case by 275% suggested

Freedom from arrhythmia at 12 months - ITT by 155% suggested

Symptomatic Atrial Arrhythmia recurrence by 76% suggested

Any Atrial Arrhythmia Recurrence by 71% suggested

Adverse events by 52% suggested

Endpoint	TE [95% CI]	p val	I2	n	k
death or hospitalization for cardiac causes	0.83 [0.74 0.93]	p=0.04	0	2204	1	CABANA,
death, stroke,stroke, serious bleeding, cardiac arrest	0.86 [0.65 1.14]	p=1.00	0	2204	1	CABANA,
Atrial fibrillation recurrence	0.53 [0.46 0.61]	p=0.04	0	2204	1	CABANA,
atrial tachyarrhythmia recurrence free survival	3.53 [2.37 5.25]	p=0.04	0	661	6	Wazni , APAF (Pappone), CAFCOAF (Stabile), Krittayaphong, ThermoCool AF, Forleo,
Freedom from arrhythmia at 12 months per protocol	3.99 [2.66 6.00]	p=0.04	0	755	7	A4 (Jais), Wazni , APAF (Pappone), CAFCOAF (Stabile), Krittayaphong, Oral, Forleo,
freedom from arrhythmia at 12 months - worst case	3.75 [2.53 5.55]	p=0.04	0	763	7	A4 (Jais), Wazni , APAF (Pappone), CAFCOAF (Stabile), Krittayaphong, Oral, Forleo,
Freedom from arrhythmia at 12 months - ITT	2.55 [1.69 3.83]	p=0.04	0	763	7	A4 (Jais), Wazni , APAF (Pappone), CAFCOAF (Stabile), Krittayaphong, Oral, Forleo,
Symptomatic Atrial Arrhythmia recurrence	0.24 [0.15 0.39]	p=0.04	0	167	1	ThermoCool AF,
Any Atrial Arrhythmia Recurrence	0.29 [0.18 0.46]	p=0.04	0	167	1	ThermoCool AF,
All cause death	0.84 [0.60 1.18]	p=1.00	0	3781	8	A4 (Jais), Wazni , APAF (Pappone), CAFCOAF (Stabile), Krittayaphong, ThermoCool AF, Forleo, CABANA,
Adverse events	0.48 [0.25 0.92]	p=0.04	0	432	4	Wazni , APAF (Pappone), CAFCOAF (Stabile), Krittayaphong,

Trial	Studied treatment	Control	Patients
A4 (Jais), 2008	catheter ablation	antiarrhythmic drugs	patients with paroxysmal AF resistant to at least 1 antiarrhythmic drug.
Wazni , 2005	Pulmonary vein isolation	Flecainide, propafenone, or sotalol; amiodarone if needed	Drug-naive monthly symptomatic AF >=3mo
APAF (Pappone), 2006	left atrial catheter ablation	Flecainide acetate, propafenone hydrochloride, or sotalol hydrochloride	Drug-refractory paroxysmal AF >=6mo
CAFCOAF (Stabile), 2006	left atrial catheter ablation plus amiodarone or other drugs	Amiodarone or other drugs	Drug-refractory or drug-intolerant paroxysmal or persistent AF
Krittayaphong, 2003	left atrial catheter ablation	amiodarone	drug-refractory amiodarone-naive paroxysmal or persistent AF >=6mo
ThermoCool AF, 2008	catheter ablation	antiarrhythmic drug therapy with a class I or III drug	patients with AF who were nonresponsive to previous treatment with antiarrhythmic drugs
Oral, 2006	circumferential pulmonary-vein ablation and amiodarione	amiodarone and two cardioversions during the first three months alone	patients with chronic atrial fibrillation
Forleo, 2009	pulmonary vein isolation	antiarrhythmic drug treatment	patients with diabetes mellitus type 2 and paroxysmal or persistent AF
Lakkireddy, 2006
CABANA, 2018	left atrial catheter ablation	current state-of-the-art therapy with either rate control or rhythm control drugs	patients with untreated or incompletely treated AF
STOP-AF, 2010	cryo-balloon catheter for pulmonary vein isolation	nonfailed antiarrhythmic drugs	patients with paroxysmal atrial fibrillation

Catheter ablation

VT or VF by 39% suggested

hospitalisation for cardiovascular causes by 45% suggested

Appropriate ICD shock by 49% suggested

ICD events by 62% suggested