Catheter ablation reduces serious adverse events and unplanned hospitalizations by 20% and 47% in atrial fibrillationCatheter Ablation Shows Lower Risk for Atrial Fibrillation Patients

BACKGROUND: Catheter ablation (CA) is superior to antiarrhythmic drugs (AADs) for maintaining sinus rhythm in atrial fibrillation (AF). However, most randomized controlled trials lack the power to assess CA safety. OBJECTIVE: This study aimed to evaluate complication rates and relative risks of CA compared with AADs for AF rhythm management. METHODS: MEDLINE, Embase, and Cochrane CENTRAL (from inception to October 24, 2024) were searched for randomized controlled trials comparing CA with AADs in AF management. The primary endpoint was a composite of serious adverse events (SAEs), including death, additional intervention, prolonged or unplanned hospitalization or disability. Secondary endpoints included SAE components. A random-effects meta-analysis estimated pooled risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS: 24 randomized trials comprising 6665 participants were included in the meta-analysis, with 3554 patients (53.2%) assigned to the CA group and 3111 patients (46.7%) to the AAD group. During a 12-month median follow-up (6-60 months), CA was associated with a 20% lower risk of SAE than AAD (RR 0.80, 95% CI 0.69-0.93, I 0%, P < .01) and 47% reduction in risk unplanned hospitalization (RR 0.53, 95% CI 0.38-0.72, I 73%, P < .01). CA was also associated with a 37% lower risk of adverse cardiovascular events (RR 0.63, 95% CI 0.44-0.90, I2 42%, P = .01). CONCLUSION: CA for AF rhythm management reduced SAEs, unplanned hospitalization and adverse cardiovascular events compared with AADs. When patient safety is being considered, AAD appears to have a less favorable safety profile than CA in AF.