학술논문
Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation: Meta-Analysis of Quality of Life, Morbidity, and Mortality.
Document Type
Academic Journal
Author
Siontis KC; Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.; Ioannidis JPA; Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA; Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford, California, USA.; Katritsis GD; Oxford University Clinical Academic Graduate School, Radcliffe Hospital, Oxford, United Kingdom.; Noseworthy PA; Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.; Packer DL; Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.; Hummel JD; Division of Cardiology, Ohio State University Wexner Medical Center, Ohio State University, Columbus, Ohio, USA.; Jais P; Hôpital Cardiologique du Haut-L'évêque, l'Université Victor Segalen Bordeaux II, Institut LYRIC, Bordeaux, France.; Krittayaphong R; Division of Cardiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.; Mont L; Thorax Institute (ICT), Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.; Morillo CA; Cardiology Division, Department of Medicine, Arrhythmia Service, Hamilton Health Sciences, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada.; Nielsen JC; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.; Oral H; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.; Pappone C; Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy.; Santinelli V; Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy.; Weerasooriya R; University of Western Australia, Crawley, Australia.; Wilber DJ; Division of Cardiology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois.; Gersh BJ; Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.; Josephson ME; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.; Katritsis DG; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: dkatrits@bidmc.harvard.edu.
Source
Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101656995 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2405-5018 (Electronic) Linking ISSN: 2405500X NLM ISO Abbreviation: JACC Clin Electrophysiol Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
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.
(Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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.
(Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)