Maintaining sinus rhythm in patients with atrial fibrillation : catheter ablation or anti-arrhythmic drugs?

Abstract

Introduction: Paroxysmal atrial fibrillation is the leading cause of progression to more persistent forms of atrial fibrillation. In Malta, between 2008 and 2011, 1704 patients were admitted with a primary cause of atrial fibrillation. Another 991 patients were noted to have AF on admission or had atrial fibrillation caused by an underlying condition. Anti-arrhythmic drugs and anti-coagulation therapy are primary treatments given to patients with atrial fibrillation. However, several studies were conducted by various researchers in order to investigate and analyse the effect of catheter ablation in the management of atrial fibrillation. Objectives: To investigate whether catheter ablation could maintain sinus rhythm more effectively than anti-arrhythmic drugs. The PICO question guiding this review of evidence was: In adults with AF, is catheter ablation more effective than antiarrhythmic drugs in maintaining sinus rhythm for up to 12 months? Method: A search was performed from the year 2000 to 30th November 2011, utilising the key-terms "atrial fibrillation", "catheter ablation" I "radiofrequency catheter ablation", and "anti-arrhythmic drugs" I "anti-arrhythmic agents". The following databases were utilised for the purpose of identifying relevant studies; PubMed, CINAHL Plus with full text, Academic Search Complete, and Cochrane Central Register of Controlled Trials I Cochrane Central Register of Systematic Review. MEDLINE ProQuest combined with other databases, such as Health & Safety Science Abstract, International Pharmaceutical Abstract, Physical Education Index, Pilots and ToxLine. Nine papers met the inclusion criteria for an evaluation of their methodological quality and relevance. The CONSORT 2010 checklist, the Jadad score system, and the PRISMA 2009 critical appraisal tools were used to appraise the analyses papers. Ethical issues and considerations were explored through the discussion. Findings: Although there were diverse methodologies used and inconsistencies with the drugs used in the control group and different ablation approaches in the RCTs retrieved, CA provides better treatment than AADs in the context of a one year follow-up period. Conclusion: Although catheter ablation was found to be more effective over a 12- months follow-up time span, it is a relatively new procedure and research is required to explore the current gaps in knowledge with regards to risks and long-term effects.