Meta-analysis of medical management versus catheter ablation for atrial fibrillation

doi:10.31083/j.rcm.2020.03.60

Reviews in Cardiovascular Medicine

2020, Vol. 21

Issue (3): 419-432 DOI: 10.31083/j.rcm.2020.03.60

Systematic Review

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Meta-analysis of medical management versus catheter ablation for atrial fibrillation

Yin-jun Mao¹, Hang Wang¹, Jian-xing Chen², Pin-fang Huang^1,^*(

)

¹Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Chazhong Road NO.20, Fuzhou, 350000, Fujian, P. R. China
²Department of Anesthesiology, First Affiliated Hospital of Fujian Medical University, Chazhong Road NO.20, Fuzhou, 350000, Fujian, P. R. China

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Abstract:

Several observational studies have shown a survival benefit for patients with atrial fibrillation (AF) who are treated with catheter ablation (CA) rather than medical management (MM). However, data from randomized controlled trials (RCTs) are uncertain. Therefore, we performed a meta-analysis of RCTs that compared the benefits of CA and MM in treatment of AF. We searched the Cochrane Library, PubMed, and EMBASE databases for RCTs that compared AF ablation with MM from the time of database establishment up to January 2020. The risk ratio (RR) with a 95% confidence interval (CI) was used as a measure treatment effect. Twenty-six RCTs that enrolled a total of 5788 patients were included in the meta-analysis. In this meta-analysis, the effect of AF ablation depended on the baseline level of left ventricular ejection fraction (LVEF) in the heart failure (HF) patients. AF ablation appears to be of benefit to patients with a lesser degree of advanced HF and better LVEF by reducing mortality. Meanwhile, this mortality advantage was manifested in long-term follow-up. CA increased the risk for hospitalization when it was used as first-line therapy and decreased the risk when used as second-line therapy. CA reduced recurrence of atrial arrhythmia for different types of AF (paroxysmal or persistent AF) and CA-related complications were non-negligible. There was no convincing evidence for a reduction in long-term stroke risk after AF ablation, and additional high quality RCTs are needed to address that issue.

Key words: Atrial fibrillation medical management catheter ablation stroke mortality

Submitted: 14 April 2020 Revised: 25 June 2020 Accepted: 09 July 2020 Published: 30 September 2020

^*Corresponding Author(s): Pin-fang Huang E-mail: huangpinfang@fjmu.edu.cn

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Cite this article:

Yin-jun Mao, Hang Wang, Jian-xing Chen, Pin-fang Huang. Meta-analysis of medical management versus catheter ablation for atrial fibrillation. Reviews in Cardiovascular Medicine, 2020, 21(3): 419-432.

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https://rcm.imrpress.com/EN/10.31083/j.rcm.2020.03.60 OR https://rcm.imrpress.com/EN/Y2020/V21/I3/419

Fig. 1. Flow diagram showing the study selection process for the meta-analysis. The number of studies shown at the bottom of the flow chart represents studies that were ultimately considered eligible for inclusion in this meta-analysis.

Table 1. Baseline characteristics of the included trials.

Study/Year	Patients (n)	Mean age (years)	Male (%)	LAD (mm)	LVEF (%)	PEE (n)	CAD (n)	DM (n)	HTN (n)	Crossover to CA(%)	Follow up (months)
Natale et al., 2000	31/30	67 $\pm$ 8/66 $\pm$ 11	65/73	NR	49.4 $\pm$ 5/49.6 $\pm$ 3	NR	12/11	NR	NR	NR	33
Krittayaphong et al., 2003	15/15	55 $\pm$ 11/49 $\pm$ 15	73/53	39.6 $\pm$ 7.7/39.2 $\pm$ 7.1	63.7 $\pm$ 10/61.8 $\pm$ 9	0/0	NR	NR	NR	NR	12
Wazni et al., 2005	33/37	53 $\pm$ 8/54 $\pm$ 8	NR	41 $\pm$ 8/42 $\pm$ 7	53 $\pm$ 5/54 $\pm$ 6	NR	NR	NR	8/10	NR	12
Da Costa et al., 2006	52/51	78.5 $\pm$ 5/78 $\pm$ 5	79/82	43 $\pm$ 7/43 $\pm$ 6	56 $\pm$ 14/54 $\pm$ 14	NR	NR	10/11	36/34	NR	13
Oral et al., 2006	77/69	55 $\pm$ 9/58 $\pm$ 8	67/62	45 $\pm$ 6/45 $\pm$ 5	55 $\pm$ 7/56 $\pm$ 7	0/0	3/4	NR	NR	77	12
Stabile et al., 2006	68/69	62 $\pm$ 9/62 $\pm$ 11	54/64	46 $\pm$ 5/45.4 $\pm$ 5.5	59.1 $\pm$ 6.7/57.9 $\pm$ 5.8	NR	NR	NR	36/34	52	12
Pappone et al., 2006	99/99	55 $\pm$ 10/57 $\pm$ 10	70/65	40 $\pm$ 6/38 $\pm$ 6	60 $\pm$ 8/61 $\pm$ 6	NR	2/2	5/4	56/57	42	12
Jais et al., 2008	53/59	50 $\pm$ 11/52 $\pm$ 11	85/83	39.5 $\pm$ 6/40 $\pm$ 6	63 $\pm$ 11/66 $\pm$ 7	1/7	NR	1/2	11/18	63	12
Forleo et al., 2009	35/35	63 $\pm$ 9/65 $\pm$ 7	57/65	44 $\pm$ 6/45.2 $\pm$ 5	54.6 $\pm$ 7/52.6 $\pm$ 9	5/3	7/7	35/35	22/24	NR	12
Wilber et al., 2010	106/61	56 $\pm$ 9/56 $\pm$ 13	69/62	40 $\pm$ 1.1/40 $\pm$ 1.5	62.3 $\pm$ 2/62.7 $\pm$ 2	2/2	NR	10/7	51/30	59	9
MacDonald et al., 2011	22/19	62 $\pm$ 7/64 $\pm$ 8	77/79	NR	16.1 $\pm$ 7.1/19.6 $\pm$ 5.5	2/2	11/9	7/4	14/11	0	6
Nielsen et al., 2012	146/148	56 $\pm$ 9/54 $\pm$ 10	68/72	40 $\pm$ 6/40 $\pm$ 5	$>$ 60/ $>$ 60	6/5	6/2	6/10	43/53	36	24
Packer et al., 2013	163/82	57 $\pm$ 9/56 $\pm$ 9	77/78	40 $\pm$ 5/41 $\pm$ 6	60 $\pm$ 6/61 $\pm$ 6	0/0	13/8	11/7	67/37	79	12
Pokushalov et al., 2013	77/77	56 $\pm$ 7/57 $\pm$ 7	73/77	45 $\pm$ 7/46 $\pm$ 5	57 $\pm$ 6/58 $\pm$ 5	5/6	8/10	9/7	24/29	56	36
Jones et al., 2013	26/26	64 $\pm$ 10/62 $\pm$ 9	81/92	50 $\pm$ 6/46 $\pm$ 7	22 $\pm$ 8/25 $\pm$ 7	NR	11/13	NR	NR	3.8	12
Zhang et al., 2014	101/100	60 $\pm$ 11/58 $\pm$ 10	70/67	45.8 $\pm$ 6/45.7 $\pm$ 6	57.9 $\pm$ 6/57.5 $\pm$ 7	10/6	11/13	19/20	52/48	24	24
Mont et al., 2014	98/48	55 $\pm$ 9/55 $\pm$ 9	78/77	41 $\pm$ 5/42 $\pm$ 5	61 $\pm$ 8/60 $\pm$ 9	4/2	NR	NR	46/19	48	12
Hummel et al., 2014	138/72	60 $\pm$ 8/61 $\pm$ 8	83/83	45 $\pm$ 5/46 $\pm$ 5	54 $\pm$ 7/55 $\pm$ 6	0/0	28/12	22/8	84/40	60	6
Hunter et al., 2014	26/24	55 $\pm$ 12/60 $\pm$ 10	96/96	52 $\pm$ 11/50 $\pm$ 10	31.8 $\pm$ 7.7/33.7 $\pm$ 12	NR	NR	NR	8/8	0	6
Morillo et al., 2014	66/61	56 $\pm$ 9/54 $\pm$ 12	77/74	40 $\pm$ 5/43 $\pm$ 5	61.4 $\pm$ 5/60.8 $\pm$ 7	3/4	6/2	1/4	28/25	43	24
Sohara et al., 2016	100/43	59 $\pm$ 10/61 $\pm$ 10	80/81	38.3 $\pm$ 6/38.3 $\pm$ 5	66.7 $\pm$ 6/66.5 $\pm$ 7	NR	3/2	3/4	51/24	79	9
Di Biase et al., 2016	102/101	62 $\pm$ 10/60 $\pm$ 11	75/73	47 $\pm$ 4.2/48 $\pm$ 4.9	29 $\pm$ 5/30 $\pm$ 8	NR	63/66	22/24	46/48	NR	24
Prabhu et al., 2017	33/33	59 $\pm$ 11/62 $\pm$ 9	94/88	48 $\pm$ 5.5/47 $\pm$ 8.2	32 $\pm$ 9/34 $\pm$ 8	2/0	0/0	4/5	13/12	9	6
Marrouche et al., 2018	179/184	64 $\pm$ 3/64 $\pm$ 3	87/84	48 $\pm$ 1.5/49.5 $\pm$ 8.3	31.5 $\pm$ 1.7/32.5 $\pm$ 2.2	21/21	72/96	43/67	129/136	15.6	38
Packer et al., 2019	1108/1096	68 $\pm$ 5/67 $\pm$ 5	63/63	NR	NR	117/103	201/216	280/281	876/900	27.5	48
Kuck et al., 2019	100/95	65 $\pm$ 8/65 $\pm$ 8	88/92	50 $\pm$ 6/51 $\pm$ 5	28 $\pm$ 9.5/24 $\pm$ 8.8	NR	30/40	24/22	56/55	4	12
Data are presented as patients receiving CA/patients receiving MM. Age is given as mean $\pm{}$ SD. CA: catheter ablation; CAD: coronary artery disease; DM: diabetes mellitus; HTN: hypertension; LAD: left atrial diameter; LVEF: left ventricular ejection fraction; MM: medical management; NR: not reported; PEE: previous embolic events.

Table 2. Risks of bias in the included trials according to the Cochrane risk of bias assessment tool.

Fig. 2. The pooled outcome of all-cause mortality. A forest plot illustrating the all-cause mortality during follow-up among AF patients randomized to CA versus MM. Packer-(Non-HF), Packer-(HF), and Marrouche-(AHF) used composite endpoints.

Fig. 3. Sensitivity analysis for all-cause mortality. (A) Sensitivity analysis for all-cause mortality among patients without HF. (B) Sensitivity analysis for all-cause mortality among patients with HF. (C) Sensitivity analysis for all-cause mortality among patients with AHF.

Fig. 4. The pooled outcome of hospitalization risk for patients treated with CA versus MM. A forest plot illustrating results of the subgroup analysis that was performed based on CA provided as first-line or second-line therapy (upper panel shows the pooled outcome for CA when used as first-line therapy; lower panel shows the pooled outcome for CA when used as second-line therapy).

Fig. 5. The pooled outcome of hospitalization risk when CA was used as first-line therapy. A forest plot illustrating the risk of hospitalization when CA was performed as first-line treatment, after excluding the study by Wazni et al. (2005).

Fig. 6. The pooled outcome of stroke/TIA risk associated with CA versus MM. The forest plot illustrates results of a subgroup analysis that was performed based on the source of stroke (upper panel shows the pooled outcome for stroke directly induced by AF itself; lower panel shows the pooled outcome for stroke caused by ablation procedure).

Fig. 7. The pooled outcome of peri-procedural complications in the CA group versus the MM group. The forest plot illustrates results of the stratification analysis that was performed based on the types of complications (upper panel shows the pooled outcome for major bleeding, the middle panel shows the pooled outcome for pulmonary vein stenosis, and lower panel shows the pooled outcome for pericardial complications).

Table 3. Complications related to CA.

	Death, N (%)	Stroke/ TIA, N (%)	Major bleeding, N (%)	Pulmonary vein stenosis, N (%)	Pericardial complications, N (%)
Natale (N $=$ 31)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Krittayaphong (N $=$ 15)	0 (0.0%)	1 (6.7%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Wazni (N $=$ 33)	0 (0.0%)	0 (0.0%)	0 (0.0%)	2 (6.1%)	0 (0.0%)
Da Costa (N $=$ 52)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Oral (N $=$ 77)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Stabile (N $=$ 68)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1 (1.5%)
Pappone (N $=$ 99)	0 (0.0%)	1 (1.0%)	0 (0.0%)	0 (0.0%)	1 (1.0%)
Jais (N $=$ 53)	0 (0.0%)	0 (0.0%)	2 (3.8%)	1 (1.9%)	2 (3.8%)
Forleo (N $=$ 35)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Wilber (N $=$ 106)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1 (0.9%)
MacDonald (N $=$ 22)	0 (0.0%)	0 (0.0%)	2 (9.1%)	0 (0.0%)	2 (9.1%)
Nielsen (N $=$ 146)	1 (0.7%)	1 (0.7%)	0 (0.0%)	1 (0.7%)	3 (2.1%)
Packer (2013) (N $=$ 163)	0 (0.0%)	1 (0.6%)	3 (1.8%)	5 (3.1%)	1 (0.6%)
Pokushalov (N $=$ 77)	0 (0.0%)	0 (0.0%)	2 (2.6%)	0 (0.0%)	2 (2.6%)
Jones (N $=$ 25)	0 (0.0%)	0 (0.0%)	1 (4.0%)	0 (0.0%)	1 (4.0%)
Zhang (N $=$ 101)	0 (0.0%)	2 (2.0%)	1 (1.0%)	0 (0.0%)	1 (1.0%)
Mont (N $=$ 98)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1 (1.0%)	3 (3.1%)
Hummel (N $=$ 138)	0 (0.0%)	4 (2.9%)	0 (0.0%)	5 (3.6%)	5 (3.6%)
Hunter (N $=$ 26)	0 (0.0%)	1 (3.8%)	1 (3.8%)	0 (0.0%)	1 (3.8%)
Morillo (N $=$ 66)	0 (0.0%)	0 (0.0%)	4 (6.0%)	1 (1.5%)	4 (6.1%)
Sohara (N $=$ 100)	0 (0.0%)	2 (2.0%)	0 (0.0%)	7 (7.0%)	0 (0.0%)
Di Biase (N $=$ 102)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1 (1.0%)
Prabhu (N $=$ 33)	0 (0.0%)	0 (0.0%)	2 (6.0%)	0 (0.0%)	0 (0.0%)
Marrouche (N $=$ 179)	0 (0.0%)	0 (0.0%)	4 (2.2%)	1 (0.6%)	3 (1.7%)
Packer (2019) (N $=$ 1108)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1 (0.09%)	8 (0.7%)
Kuck (N $=$ 98)	1 (1.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	2 (2.0%)
Total (N $=$ 3051)	2 (0.06%)	13 (0.4%)	22 (0.7%)	25 (0.8%)	42 (1.4%)

Table 4. Outcome for recurrence of atrial arrhythmia in AF patients with normal or reduced LVEF who underwent CA or MM in the included trials.

Follow-up duration
Recurrence of atrial arrhythmia	No. of studies	Patients CA/MM	Events CA/MM	P value	Effect estimate RR (95% CI)	I ${}^{2}$	Incidence after CA/MM
Overall	26	2533/2249	882/1525	$<$ 0.00001	0.43 (0.37, 0.51)	82%	34.8%/67.8%
Follow-up $\geq$ 1 year	20	2113/2003	730/1309	$<$ 0.00001	0.43 (0.36, 0.53)	83%	34.5%/65.4%
Follow-up $\geq$ 2 years	8	1313/1330	531/858	$<$ 0.00001	0.58 (0.48, 0.69)	72%	40.4%/64.5%
Follow-up $\geq$ 3 years	3	867/890	398/623	0.001	0.60 (0.45, 0.82)	85%	45.9%/70%
Follow-up $\geq$ 4 years	1	611/629	305/437	$<$ 0.00001	0.72 (0.65, 0.79)	—	49.9%/69.5%
Type of MM
CA vs. rhythm control	14	992/863	291/617	$<$ 0.00001	0.38 (0.30, 0.49)	76%	29.3%/71.5%
CA vs. rate control	4	104/101	18/99	0.008	0.17 (0.05, 0.63)	88%	17.3%/98%
Number of ablation
Single ablation	12	756/606	311/481	$<$ 0.00001	0.51 (0.45, 0.58)	46%	41.1%/79%
Multiple ablations	19	2330/2102	804/1401	$<$ 0.00001	0.45 (0.38, 0.54)	83%	34.5%/66.7%
Type of AF
Paroxysmal AF	7	864/799	287/527	0.0001	0.43 (0.29, 0.66)	93%	33.2%/66%
Persistent AF	8	803/743	308/475	$<$ 0.00001	0.54 (0.44, 0.68)	66%	38.4%/63.9%
Level of LVEF
Normal LVEF	19	1966/1675	696/1116	$<$ 0.00001	0.44 (0.37, 0.54)	83%	35.4%/66.6%
Reduced LVEF	8	567/566	186/409	$<$ 0.00001	0.42 (0.30, 0.60)	81%	32.8%/72.2%
AF: atrial fibrillation; CA: catheter ablation; CI: confidence interval; LVEF: left ventricular ejection fraction; MM: medical management; RR: risk ratio.

Fig. 8. A Begg’s funnel plot of all studies included in the meta-analysis. The absence of asymmetry indicates that there was no publication bias.

[1]	Andrade, J. G., Champagne, J., Deyell, M. W., Essebag, V., Lauck, S., Morillo, C., Sapp, J., Skanes, A., Theoret-Patrick, P., Wells, G. A. and Verma, A. (2018) A randomized clinical trial of early invasive intervention for atrial fibrillation (EARLY-AF) - methods and rationale. American Heart Journal 206, 94-104.
[2]	Arbelo, E., Brugada, J., Hindricks, G., Maggioni, A. P., Tavazzi, L., Vardas, P., Laroche, C., Anselme, F., Inama, G., Jais, P., Kalarus, Z., Kautzner, J., Lewalter, T., Mairesse, G. H., Perez-Villacastin, J., Riahi, S., Taborsky, M., Theodorakis, G. and Trines, S. A. (2014) The atrial fibrillation ablation pilot study: a European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association. European Heart Journal 35, 1466-1478.
[3]	Asad, Z. U. A., Yousif, A., Khan, M. S., Al-Khatib, S. M. and Stavrakis, S. (2019) Catheter ablation versus medical therapy for atrial fibrillation. Circulation: Arrhythmia and Electrophysiology 12, e007414.
[4]	Asirvatham, S. J. and Friedman, P. A. (2006) Silent cerebral thromboembolism with left atrial ablation: a lurking danger. Journal of Cardiovascular Electrophysiology 17, 8-10.
[5]	Chen, S., Pürerfellner, H., Meyer, C., DZHK (German Centre for Cardiovascular Research), Partner Site HamburgKielLübeck, Germany, Acou, W., Schratter, A., Ling, Z., Liu, S., Yin, Y., Martinek, M., Kiuchi, M. G., Schmidt, B. and Chun, K. R. J. (2019) Rhythm control for patients with atrial fibrillation complicated with heart failure in the contemporary era of catheter ablation: a stratified pooled analysis of randomized data. European Heart Journal (in press).
[6]	Chiang, C., Okumura, K., Zhang, S., Chao, T., Siu, C., Wei Lim, T., Saxena, A., Takahashi, Y. and Siong Teo, W. (2017) 2017 consensus of the asia pacific heart rhythm society on stroke prevention in atrial fibrillation. Journal of Arrhythmia 33, 345-367.
[7]	Choi, A. D., Hematpour, K., Kukin, M., Mittal, S. and Steinberg, J. S. (2010) Ablation vs medical therapy in the setting of symptomatic atrial fibrillation and left ventricular dysfunction. Congestive Heart Failure 16, 10-14.
[8]	Chugh, S. S., Havmoeller, R., Narayanan, K., Singh, D., Rienstra, M., Benjamin, E. J., Gillum, R. F., Kim, Y., McAnulty, J. H., Zheng, Z., Forouzanfar, M. H., Naghavi, M., Mensah, G. A., Ezzati, M. and Murray, C. J. L. (2014) Worldwide epidemiology of atrial fibrillation. Circulation 129, 837-847.
[9]	Da Costa, A., Thévenin, J., Roche, F., Romeyer-Bouchard, C., Abdellaoui, L., Messier, M., Denis, L., Faure, E., Gonthier, R., Kruszynski, G., Pages, J. M., Bonijoly, S., Lamaison, D., Defaye, P., Barthélemy, J. C., Gouttard, T., Isaaz, K. and Loire-Ardèche-Drôme-Isère-Puy-de-Dôme Trial of Atrial Flutter Investigators (2006). Results from the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) trial on atrial flutter, a multicentric prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter. Circulation 114, 1676–1681.
[10]	Di Biase, L., Mohanty, P., Mohanty, S., Santangeli, P., Trivedi, C., Lakkireddy, D., Reddy, M., Jais, P., Themistoclakis, S., Dello Russo, A., Casella, M., Pelargonio, G., Narducci, M. L., Schweikert, R., Neuzil, P., Sanchez, J., Horton, R., Beheiry, S., Hongo, R., Hao, S., Rossillo, A., Forleo, G., Tondo, C., Burkhardt, J. D., Haissaguerre, M. and Natale, A. (2016) Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device. Circulation 133, 1637-1644.
[11]	Dyrda, K., Roy, D., Leduc, H., Talajic, M., Stevenson, L. W., Guerra, P. G., Andrade, J., Dubuc, M., Macle, L., Thibault, B., Rivard, L., Khairy, P. and Montreal Heart Institute Coordinating Center (MHICC); Montreal QC Canada (2015) Treatment failure with rhythm and rate control strategies in patients with atrial fibrillation and congestive heart failure: an AF-CHF substudy. Journal of Cardiovascular Electrophysiology 26, 1327-1332.
[12]	Egger, M., Smith, G. D., Schneider, M. and Minder, C. (1997) Bias in meta-analysis detected by a simple, graphical test. Bmj 315, 629-634.
[13]	Forleo, G. B., Mantica, M., De Luca, L., Leo, R., Santini, L., Panigada, S., De Sanctis, V., Pappalardo, A., Laurenzi, F., Avella, A., Casella, M., Dello Russo, A., Romeo, F., Pelargonio, G. and Tondo, C. (2009) Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy. Journal of Cardiovascular Electrophysiology 20, 22-28.
[14]	Ganesan, A. N., Shipp, N. J., Brooks, A. G., Kuklik, P., Lau, D. H., Lim, H. S., Sullivan, T., Roberts-Thomson, K. C. and Sanders, P. (2013) Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Journal of the American Heart Association 2, e004549.
[15]	Gentlesk, P. J., Sauer, W. H., Gerstenfeld, E. P., Lin, D., Dixit, S., Zado, E., Callans, D. and Marchlinski, F. E. (2007) Reversal of left ventricular dysfunction following ablation of atrial fibrillation. Journal of Cardiovascular Electrophysiology 18, 9-14.
[16]	Hagens, V. E., Crijns, H. J. G. M., Van Veldhuisen, D. J., Van Den Berg, M. P., Rienstra, M., Ranchor, A. V., Bosker, H. A., Kamp, O., Tijssen, J. G. P., Veeger, N. J. G. M. and Van Gelder, I. C. (2005) Rate control versus rhythm control for patients with persistent atrial fibrillation with mild to moderate heart failure: Results from the RAte Control versus Electrical cardioversion (RACE) study. American Heart Journal 149, 1106-1111.
[17]	Hart, R. G., Pearce, L. A. and Aguilar, M. I. (2007) Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Annals of Internal Medicine 146, 857.
[18]	Herrera, S. C., Deneke, T., Hocini, M., Lehrmann, H., Shin, D., Miyazaki, S., Henschke, S., Fluegel, P., Schiebeling-Römer, J., Bansmann, P. M., Bourdias, T., Dousset, V., Haïssaguerre, M. and Arentz, T. (2011) Incidence of Asymptomatic Intracranial Embolic Events After Pulmonary Vein Isolation. Journal of the American College of Cardiology 58, 681-688.
[19]	Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., Cochrane Bias Methods Group and Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343, d5928-d5928.
[20]	Hummel, J., Michaud, G., Hoyt, R., DeLurgio, D., Rasekh, A., Kusumoto, F., Giudici, M., Dan, D., Tschopp, D., Calkins, H. and Boersma, L. (2014) Phased RF ablation in persistent atrial fibrillation. Heart Rhythm 11, 202-209.
[21]	Hunter, R. J., Berriman, T. J., Diab, I., Kamdar, R., Richmond, L., Baker, V., Goromonzi, F., Sawhney, V., Duncan, E., Page, S. P., Ullah, W., Unsworth, B., Mayet, J., Dhinoja, M., Earley, M. J., Sporton, S. and Schilling, R. J. (2014) A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (The CAMTAF Trial). Circulation: Arrhythmia and Electrophysiology 7, 31-38.
[22]	Jais, P., Cauchemez, B., Macle, L., Daoud, E., Khairy, P., Subbiah, R., Hocini, M., Extramiana, F., Sacher, F., Bordachar, P., Klein, G., Weerasooriya, R., Clémenty, J. and Haïssaguerre, M. (2008) Catheter ablation versus antiarrhythmic drugs for atrial fibrillation. Circulation 118, 2498-2505.
[23]	Jones, D. G., Haldar, S. K., Hussain, W., Sharma, R., Francis, D. P., Rahman-Haley, S. L., McDonagh, T. A., Underwood, S. R., Markides, V. and Wong, T. (2013) A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. Journal of the American College of Cardiology 61, 1894-1903.
[24]	Khan, S. U., Rahman, H., Talluri, S. and Kaluski, E. (2018) The clinical benefits and mortality reduction associated with catheter ablation in subjects with atrial fibrillation: a systematic review and meta-analysis. Journal of the American College of Cardiology-Clinical Electrophysiology 4, 626-635.
[25]	Khaykin, Y., Wang, X., Natale, A., Wazni, O. M., Skanes, A. C., Humphries, K. H., Kerr, C. R., Verma, A. and Morillo, C. A. (2009) Cost comparison of ablation versus antiarrhythmic drugs as first-line therapy for atrial fibrillation: an economic evaluation of the RAAFT pilot study. Journal of Cardiovascular Electrophysiology 20, 7-12.
[26]	Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H., Heidbuchel, H., Hendriks, J., Hindricks, G., Manolis, A. S., Oldgren, J., Popescu, B. A., Schotten, U., Putte, B. V. and Vardas, P. (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. . European Heart Journal 37, 2893–2962.
[27]	Kirchhof, P., Breithardt, G., Camm, A. J., Crijns, H. J., Kuck, K., Vardas, P. and Wegscheider, K. (2013) Improving outcomes in patients with atrial fibrillation: Rationale and design of the Early treatment of Atrial fibrillation for Stroke prevention Trial. American Heart Journal 166, 442-448.
[28]	Krittayaphong, R., Raungrattanaamporn, O., Bhuripanyo, K., Sriratanasathavorn, C., Pooranawattanakul, S., Punlee, K. and Kangkagate, C. (2003) A randomized clinical trial of the efficacy of radiofrequency catheter ablation and amiodarone in the treatment of symptomatic atrial fibrillation. Journal of the Medical Association of Thailand 86 Suppl 1, S8-16.
[29]	Kuck, K., Merkely, B., Zahn, R., Arentz, T., Seidl, K., Schlüter, M., Tilz, R. R., Piorkowski, C., Gellér, L., Kleemann, T. and Hindricks, G. (2019) Catheter ablation versus best medical therapy in patients with persistent atrial fibrillation and congestive heart failure. Circulation: Arrhythmia and Electrophysiology 12, e007731.
[30]	Lloyd-Jones, D. M., Wang, T. J., Leip, E. P., Larson, M. G., Levy, D., Vasan, R. S., D’Agostino, R. B., Massaro, J. M., Beiser, A., Wolf, P. A. and Benjamin, E. J. (2004) Lifetime risk for development of atrial fibrillation. Circulation 110, 1042-1046.
[31]	MacDonald, M. R., Connelly, D. T., Hawkins, N. M., Steedman, T., Payne, J., Shaw, M., Denvir, M., Bhagra, S., Small, S., Martin, W., McMurray, J. J. V. and Petrie, M. C. (2011) Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: a randomised controlled trial. Heart 97, 740-747.
[32]	Mansour, M., Heist, E. K., Agarwal, R., Bunch, T. J., Karst, E., Ruskin, J. N. and Mahapatra, S. (2018) Stroke and cardiovascular events after ablation or antiarrhythmic drugs for treatment of patients with atrial fibrillation. The American Journal of Cardiology 121, 1192-1199.
[33]	Marrouche, N. F., Brachmann, J., Andresen, D., Siebels, J., Boersma, L., Jordaens, L., Merkely, B., Pokushalov, E., Sanders, P., Proff, J., Schunkert, H., Christ, H., Vogt, J. and Bänsch, D. (2018) Catheter ablation for atrial fibrillation with heart failure. New England Journal of Medicine 378, 417-427.
[34]	Menzies, D. (2011) Systematic reviews and meta-analyses. The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union against Tuberculosis and Lung Disease 15, 582-593.
[35]	Mont, L., Bisbal, F., Hernández-Madrid, A., Pérez-Castellano, N., Viñolas, X., Arenal, A., Arribas, F., Fernández-Lozano, I., Bodegas, A., Cobos, A., Matía, R., Pérez-Villacastín, J., Guerra, J. M., Ávila, P., López-Gil, M., Castro, V., Arana, J. I. and Brugada, J. (2014) Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). European Heart Journal 35, 501-507.
[36]	Morillo, C. A., Verma, A., Connolly, S. J., Kuck, K. H., Nair, G. M., Champagne, J., Sterns, L. D., Beresh, H., Healey, J. S. and Natale, A. (2014) Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2). JAMA 311, 692.
[37]	Nademanee, K., Schwab, M. C., Kosar, E. M., Karwecki, M., Moran, M. D., Visessook, N., Michael, A. D. and Ngarmukos, T. (2008) Clinical outcomes of catheter substrate ablation for high-risk patients with atrial fibrillation. Journal of the American College of Cardiology 51, 843-849.
[38]	Natale, A., Newby, K. H., Pisanó, E., Leonelli, F., Fanelli, R., Potenza, D., Beheiry, S. and Tomassoni, G. (2000) Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. Journal of the American College of Cardiology 35, 1898-1904.
[39]	Nielsen, J. C., Johannessen, A., Raatikainen, P., Hindricks, G., Walfridsson, H., Kongstad, O., Pehrson, S., Englund, A., Hartikainen, J., Mortensen, L. S. and Hansen, P. S. (2012) Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. New England Journal of Medicine 367, 1587-1595.
[40]	Nisar, M. U., Munir, M. B., Sharbaugh, M. S., Thoma, F. W., Althouse, A. D. and Saba, S. (2018) Trends in atrial fibrillation hospitalizations in the United States: A report using data from the National Hospital Discharge Survey. Indian Pacing and Electrophysiology Journal 18, 6-12.
[41]	Oral, H., Pappone, C., Chugh, A., Good, E., Bogun, F., Pelosi, F., Bates, E. R., Lehmann, M. H., Vicedomini, G., Augello, G., Agricola, E., Sala, S., Santinelli, V. and Morady, F. (2006) Circumferential pulmonary-vein ablation for chronic atrial fibrillation. New England Journal of Medicine 354, 934-941.
[42]	Packer, D. L., Kowal, R. C., Wheelan, K. R., Irwin, J. M., Champagne, J., Guerra, P. G., Dubuc, M., Reddy, V., Nelson, L., Holcomb, R. G., Lehmann, J. W. and Ruskin, J. N. (2013) Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation. Journal of the American College of Cardiology 61, 1713-1723.
[43]	Packer, D. L., Mark, D. B., Robb, R. A., Monahan, K. H., Bahnson, T. D., Poole, J. E., Noseworthy, P. A., Rosenberg, Y. D., Jeffries, N., Mitchell, L. B., Flaker, G. C., Pokushalov, E., Romanov, A., Bunch, T. J., Noelker, G., Ardashev, A., Revishvili, A., Wilber, D. J., Cappato, R., Kuck, K., Hindricks, G., Davies, D. W., Kowey, P. R., Naccarelli, G. V., Reiffel, J. A., Piccini, J. P., Silverstein, A. P., Al-Khalidi, H. R. and Lee, K. L. (2019) Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA 321, 1261-1274.
[44]	Pappone, C., Augello, G., Sala, S., Gugliotta, F., Vicedomini, G., Gulletta, S., Paglino, G., Mazzone, P., Sora, N., Greiss, I., Santagostino, A., LiVolsi, L., Pappone, N., Radinovic, A., Manguso, F. and Santinelli, V. (2006) A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation. Journal of the American College of Cardiology 48, 2340-2347.
[45]	Patel, N. J., Deshmukh, A., Pant, S., Singh, V., Patel, N., Arora, S., Shah, N., Chothani, A., Savani, G. T., Mehta, K., Parikh, V., Rathod, A., Badheka, A. O., Lafferty, J., Kowalski, M., Mehta, J. L., Mitrani, R. D., Viles-Gonzalez, J. F. and Paydak, H. (2014) Contemporary trends of hospitalization for atrial fibrillation in the United States, 2000 through 2010. Circulation 129, 2371-2379.
[46]	Pokushalov, E., Romanov, A., De Melis, M., Artyomenko, S., Baranova, V., Losik, D., Bairamova, S., Karaskov, A., Mittal, S. and Steinberg, J. S. (2013) Progression of atrial fibrillation after a failed initial ablation procedure in patients with paroxysmal atrial fibrillation. Circulation: Arrhythmia and Electrophysiology 6, 754-760.
[47]	Prabhu, S., Taylor, A. J., Costello, B. T., Kaye, D. M., McLellan, A. J. A., Voskoboinik, A., Sugumar, H., Lockwood, S. M., Stokes, M. B., Pathik, B., Nalliah, C. J., Wong, G. R., Azzopardi, S. M., Gutman, S. J., Lee, G., Layland, J., Mariani, J. A., Ling, L., Kalman, J. M. and Kistler, P. M. (2017) Catheter ablation versus medical rate control in atrial fibrillation and systolic dysfunction. Journal of the American College of Cardiology 70, 1949-1961.
[48]	Redfield, M. M., Kay, G. N., Jenkins, L. S., Mianulli, M., Jensen, D. N. and Ellenbogen, K. A. (2000) Tachycardia-related cardiomyopathy: a common cause of ventricular dysfunction in patients with atrial fibrillation referred for atrioventricular ablation. Mayo Clinic Proceedings 75, 790-795.
[49]	Reynolds, M. R., Gunnarsson, C. L., Hunter, T. D., Ladapo, J. A., March, J. L., Zhang, M. and Hao, S. C. (2012) Health outcomes with catheter ablation or antiarrhythmic drug therapy in atrial fibrillation. Circulation: Cardiovascular Quality and Outcomes 5, 171-181.
[50]	Roy, D., Talajic, M., Nattel, S., Wyse, D. G., Dorian, P., Lee, K. L., Bourassa, M. G., Arnold, J. M. O., Buxton, A. E., Camm, A. J., Connolly, S. J., Dubuc, M., Ducharme, A., Guerra, P. G., Hohnloser, S. H., Lambert, J., Le Heuzey, J., O’Hara, G., Pedersen, O. D., Rouleau, J., Singh, B. N., Stevenson, L. W., Stevenson, W. G., Thibault, B. and Waldo, A. L. (2008) Rhythm control versus rate control for atrial fibrillation and heart failure. New England Journal of Medicine 358, 2667-2677.
[51]	Ruzieh, M., Foy, A. J., Aboujamous, N. M., Moroi, M. K., Naccarelli, G. V., Ghahramani, M., Kanjwal, S., Marine, J. E. and Kanjwal, K. (2019) Meta-analysis of atrial fibrillation ablation in patients with systolic heart failure. Cardiovascular Therapeutics 2019, 1-10.
[52]	Santhanakrishnan, R., Wang, N., Larson, M. G., Magnani, J. W., McManus, D. D., Lubitz, S. A., Ellinor, P. T., Cheng, S., Vasan, R. S., Lee, D. S., Wang, T. J., Levy, D., Benjamin, E. J. and Ho, J. E. (2016) Atrial fibrillation begets heart failure and vice versa. Circulation 133, 484-492.
[53]	Shi, L., Heng, R., Liu, S. and Leng, F. (2015) Effect of catheter ablation versus antiarrhythmic drugs on atrial fibrillation: A meta-analysis of randomized controlled trials. Experimental and Therapeutic Medicine 10, 816-822.
[54]	Sohara, H., Ohe, T., Okumura, K., Naito, S., Hirao, K., Shoda, M., Kobayashi, Y., Yamauchi, Y., Yamaguchi, Y., Kuwahara, T., Hirayama, H., YeongHwa, C., Kusano, K., Kaitani, K., Banba, K., Fujii, S., Kumagai, K., Yoshida, H., Matsushita, M., Satake, S. and Aonuma, K. (2016) Hotballoon ablation of the pulmonary veins for paroxysmal AF: a multicenter randomized trial in Japan. Journal of the American College of Cardiology 68, 2747-2757.
[55]	Stabile, G., Bertaglia, E., Senatore, G., De Simone, A., Zoppo, F., Donnici, G., Turco, P., Pascotto, P., Fazzari, M. and Vitale, D. F. (2006) Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study). European Heart Journal 27, 216-221.
[56]	Steinberg, B. A., Kim, S., Fonarow, G. C., Thomas, L., Ansell, J., Kowey, P. R., Mahaffey, K. W., Gersh, B. J., Hylek, E., Naccarelli, G., Go, A. S., Reiffel, J., Chang, P., Peterson, E. D. and Piccini, J. P. (2014) Drivers of hospitalization for patients with atrial fibrillation: results from the outcomes registry for better informed treatment of atrial fibrillation (ORBIT-AF). American Heart Journal 167, 735-742.e2.
[57]	Thakur, R. K., Hijazi, Z. M. and Natale, A. (2016) Cardioembolic Stroke. Cardiology Clinics 34, xiii-xxiv.
[58]	Virk, S. A., Bennett, R. G., Chow, C., Sanders, P., Kalman, J. M., Thomas, S. and Kumar, S. (2019) Catheter ablation versus medical therapy for atrial fibrillation in patients with heart failure: a meta-analysis of randomised controlled trials. Heart, Lung and Circulation 28, 707-718.
[59]	Wazni, O. M., Marrouche, N. F., Martin, D. O., Verma, A., Bhargava, M., Saliba, W., Bash, D., Schweikert, R., Brachmann, J., Gunther, J., Gutleben, K., Pisano, E., Potenza, D., Fanelli, R., Raviele, A., Themistoclakis, S., Rossillo, A., Bonso, A. and Natale, A. (2005) Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation. JAMA 293, 2634.
[60]	Wilber, D. J., Pappone, C., Neuzil, P., De Paola, A., Marchlinski, F., Natale, A., Macle, L., Daoud, E. G., Calkins, H., Hall, B., Reddy, V., Augello, G., Reynolds, M. R., Vinekar, C., Liu, C. Y., Berry, S. M., Berry, D. A. and ThermoCool AF Trial Investigators, F. T. (2010) Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation. JAMA 303, 333.
[61]	Wyse, D. G., Waldo, A. L., DiMarco, J. P., Domanski, M. J., Rosenberg, Y., Schron, E. B., Kellen, J. C., Greene, H. L., Mickel, M. C., Dalquist, J. E. and Corley, S. D. (2002) A comparison of rate control and rhythm control in patients with atrial fibrillation. The New England Journal of Medicine 347, 1825-1833.
[62]	Zhang, X. D., Gu, J., Jiang, W. F., Zhao, L., Zhou, L., Wang, Y. L., Liu, Y. G. and Liu, X. (2014) Optimal rhythm-control strategy for recurrent atrial tachycardia after catheter ablation of persistent atrial fibrillation: a randomized clinical trial. European Heart Journal 35, 1327-1334.

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