Evidence map›Paper›PMID 38918704›Full record

SynthesisBMC cardiovascular disorders2024

Antiarrhythmic drug therapy and catheter ablation in patients with paroxysmal or persistent atrial fibrillation: a systematic review and meta-analysis.

Subhash Chander, Roopa Kumari, Sindhu Luhana, Sheena Shiwlani, Om Parkash, Fnu Sorath, Hong Yu Wang, Sam Tan, Zubair Rahaman, Yaqub Nadeem Mohammed and 4 more

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in BMC cardiovascular disorders, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. The impact of catheter ablation in congenital heart disease and atrial fibrillation: An updated meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
    Article
  3. The Arrhythmic Burden of Cardiac Amyloidosis: A Comprehensive Review.Heart views : the official journal of the Gulf Heart Association · 2026
    Review
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Subhash ChanderDepartment of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA. chander2@buffalo.edu.
Roopa KumariDepartment of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA.
Sindhu LuhanaDepartment of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA.
Sheena ShiwlaniDepartment of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA.
Om ParkashDepartment of Medicine, Montefiore Medical Centre, Wakefield, NY, USA.
Fnu SorathDepartment of Anesthesiology, Dow University Health Sciences, Karachi, Pakistan.
Hong Yu WangDepartment of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA.
Sam TanDepartment of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA.
Zubair RahamanDepartment of Medicine, University at Buffalo, Buffalo, NY, USA.
Yaqub Nadeem MohammedDepartment of Medicine, Western Michigan University, Kalamazoo, WV, USA.
Abhi Chand LohanaDepartment of Medicine, WVU, Camden Clark Medical Centre, Parkersburg, WV, USA.
Fnu SakshiDepartment of Medicine, Piedmont Augusta Hospital, Augusta, GA, USA.
Esha VaishDepartment of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA.
Fnu SadaratDepartment of Medicine, University at Buffalo, Buffalo, NY, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCatheter ablation and antiarrhythmic drug therapy are utilized for rhythm control in atrial fibrillation (AF), but their comparative effectiveness, especially with contemporary treatment modalities, remains undefined. We conducted a systematic review and meta-analysis contrasting current ablation techniques against antiarrhythmic medications for AF.

methodsWe searched PubMed, SCOPUS, Cochrane CENTRAL, and Web of Science until November 2023 for randomized trials comparing AF catheter ablation with antiarrhythmics, against antiarrhythmic drug therapy alone, reporting outcomes for > 6 months. Four investigators extracted data and appraised risk of bias (ROB) with ROB 2 tool. Meta-analyses estimated pooled efficacy and safety outcomes using R software.

resultsTwelve trials (n = 3977) met the inclusion criteria. Catheter ablation was associated with lower AF recurrence (relative risk (RR) = 0.44, 95%CI (0.33, 0.59), P ˂ 0.0001) and hospitalizations (RR = 0.44, 95%CI (0.23, 0.82), P = 0.009) than antiarrhythmic medications. Catheter ablation also improved the physical quality of life component score (assessed by a 36-item Short Form survey) by 7.61 points (95%CI -0.70-15.92, P = 0.07); but, due to high heterogeneity, it was not statistically significant. Ablation was significantly associated with higher procedural-related complications [RR = 15.70, 95%CI (4.53, 54.38), P < 0.0001] and cardiac tamponade [RR = 9.22, 95%CI (2.16, 39.40), P = 0.0027]. All-cause mortality was similar between the two groups.

conclusionsFor symptomatic AF, upfront catheter ablation reduces arrhythmia and hospitalizations better than continued medical therapy alone, albeit with moderately more adverse events. Careful patient selection and risk-benefit assessment are warranted regarding the timing of ablation.

Indexed as

Anti-Arrhythmia AgentsAtrial FibrillationCatheter AblationRecurrenceAgedFemaleHeart RateHumansMaleMiddle AgedQuality of LifeRandomized Controlled Trials as TopicRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeAnti-Arrhythmia AgentsAntiarrhythmic agentsAtrial fibrillationCatheter ablationSystematic review

Identifiers

PMID38918704
PMCPMC11197351

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.