Efficacy and Safety of Radiofrequency Ablation versus Amiodarone for Atrial Fibrillation: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIUXiao-qi ¹ ,  ZHANGJian-ping ² , YANGMin ¹ , LAOHai-yan ¹

1. Department of Pharmacy, Guangdong General Hospital(Guangdong Academy of Medical Sciences), Guangzhou 510080, China;
2. School of Pharmacy, Jinan University, Guangzhou 510632, China;

Corresponding author：

ZHANGJian-ping, Email: tzhangjp@jnu.edu.cn

Keywords：

Radiofrequency ablation; Amiodarone; Atrial fibrillation; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20150197

Video：

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Objective To systematically evaluate the efficacy and safety of radiofrequency ablation versus amiodarone in the treatment of atrial fibrillation, so as to provide reference for the chosen of clinical treatment options. Methods We searched PubMed, The Cochrane Library (Issue 10, 2014), CNKI, VIP and WanFang data from inception to October 2014 to collect randomized controlled trials (RCTs) comparing radiofrequency ablation versus amiodarone for atrial fibrillation. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 4 RCTs involving 511 atrial fibrillation patients were included. The results of meta-analysis showed that:compared with amiodarone, radiofrequency ablation could reduce the risk of atrial fibrillation recurrence (RR=0.35, 95%CI 0.22 to 0.55, P<0.000 01). There was no significant difference in all-cause mortality (RR=0.97, 95%CI 0.17 to 5.61, P=0.97) between both groups. The incidence of adverse events in the radiofrequency ablation group was 7.7%, and was lower than 12.7% of the amiodarone group, but there was no significant difference between the two groups. Conclusion Current evidence shows that, compared with amiodarona, radiofrequency ablation is related to lower recurrence rate and higher efficacy, but there is no difference in the safety between the two interventions. However, due to the limited quality and quantity of included studies, higher quality studies are needed to verify the above conclusion.

Citation： LIUXiao-qi, ZHANGJian-ping, YANGMin, LAOHai-yan. Efficacy and Safety of Radiofrequency Ablation versus Amiodarone for Atrial Fibrillation: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(10): 1190-1195. doi: 10.7507/1672-2531.20150197 Copy

1.	Zhang S. Sudden Cardiac Death in China. Pacing Clin Electrophysiol, 2009, 32(9):1159-1162.
2.	Lafuente-Lafuente C, Mouly S, Longas-Tejero MA, et al. Antiarrhythmic drugs for maintaining sinus rhythm after cardioversion of atrial fibrillation:a systematic review of randomized controlled trials. Arch Intern Med, 2006, 166(7):719-728.
3.	Connolly SJ. Evidence-based analysis of amiodarone efficacy and safety. Circulation, 1999, 100(19):2025-2034.
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5.	Camm AJ, Lip GYH, Caterina RD, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J, 2012, 33(21):2719-2747.
6.	Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation:recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol, 2012, 33(2):171-257.
7.	黄从新, 张澍, 马长生, 等. 心房颤动:目前的认识和治疗建议——2012. 中华心律失常学杂志, 2012, 16(4):246-289.
8.	黄从新, 张澍, 马长生, 等. 中国经导管消融治疗心房颤动注册研究10年回顾. 中华心律失常学杂志, 2009, 13(4):296-302.
9.	Krittayaphong R, Raungrattanaamporn O, Bhuripanyo K, et al. A randomized clinical trial of the efficacy of radiofrequency catheter ablation and amiodarone in the treatment of symptomatic atrial fibrillation. J Med Assoc Thai, 2003, 86 (Suppl 1):S8-16.
10.	Oral H, Augello G, Agricola E, et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med, 2006, 354(9):934-941.
11.	Pappone C, Augello G, Sala S, et al. A Randomized Trial of Circumferential Pulmonary Vein Ablation Versus Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation:The APAF Study. J Am Coll Cardiol, 2006, 48(11):2340-2347.
12.	Stabile G, Bertaglia E, Senatore G, et al. 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). Eur Heart J, 2006, 27(2):216-221.
13.	黄从新, 马长生, 张澍, 等. 经导管消融心房颤动中国专家共识. 中华心律失常学杂志, 2008, 12(4):248-258.
14.	张涛, 郭继鸿. 2012HRS/EHRA/ECAS心房颤动导管消融和外科消融专家共识解读. 中华医学杂志, 2012, 92(38):2671-2673.
15.	刘鸣. 系统评价、Meta分析设计与实施方法. 第1版. 北京:人民卫生出版社, 2011:128.
16.	Calkins H, Reynolds MR, Spector P, et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation:two systematic literature reviews and meta-analyses. Circ-Arrhythmia Elec, 2009, 2(4):349-361.
17.	钟黛云, 刘爱军, 骆楚君, 等. 射频消融术与胺碘酮比较治疗房颤的药物经济学评价. 中国循证医学杂志, 2015, 15(9):1018-1023.

1. Zhang S. Sudden Cardiac Death in China. Pacing Clin Electrophysiol, 2009, 32(9):1159-1162.
2. Lafuente-Lafuente C, Mouly S, Longas-Tejero MA, et al. Antiarrhythmic drugs for maintaining sinus rhythm after cardioversion of atrial fibrillation:a systematic review of randomized controlled trials. Arch Intern Med, 2006, 166(7):719-728.
3. Connolly SJ. Evidence-based analysis of amiodarone efficacy and safety. Circulation, 1999, 100(19):2025-2034.
4. Fuster V, Rydén LE, Cannom DS, et al. 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial FibrillationA Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol, 2011, 57(11):e101-e198.
5. Camm AJ, Lip GYH, Caterina RD, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J, 2012, 33(21):2719-2747.
6. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation:recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol, 2012, 33(2):171-257.
7. 黄从新, 张澍, 马长生, 等. 心房颤动:目前的认识和治疗建议——2012. 中华心律失常学杂志, 2012, 16(4):246-289.
8. 黄从新, 张澍, 马长生, 等. 中国经导管消融治疗心房颤动注册研究10年回顾. 中华心律失常学杂志, 2009, 13(4):296-302.
9. Krittayaphong R, Raungrattanaamporn O, Bhuripanyo K, et al. A randomized clinical trial of the efficacy of radiofrequency catheter ablation and amiodarone in the treatment of symptomatic atrial fibrillation. J Med Assoc Thai, 2003, 86 (Suppl 1):S8-16.
10. Oral H, Augello G, Agricola E, et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med, 2006, 354(9):934-941.
11. Pappone C, Augello G, Sala S, et al. A Randomized Trial of Circumferential Pulmonary Vein Ablation Versus Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation:The APAF Study. J Am Coll Cardiol, 2006, 48(11):2340-2347.
12. Stabile G, Bertaglia E, Senatore G, et al. 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). Eur Heart J, 2006, 27(2):216-221.
13. 黄从新, 马长生, 张澍, 等. 经导管消融心房颤动中国专家共识. 中华心律失常学杂志, 2008, 12(4):248-258.
14. 张涛, 郭继鸿. 2012HRS/EHRA/ECAS心房颤动导管消融和外科消融专家共识解读. 中华医学杂志, 2012, 92(38):2671-2673.
15. 刘鸣. 系统评价、Meta分析设计与实施方法. 第1版. 北京:人民卫生出版社, 2011:128.
16. Calkins H, Reynolds MR, Spector P, et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation:two systematic literature reviews and meta-analyses. Circ-Arrhythmia Elec, 2009, 2(4):349-361.
17. 钟黛云, 刘爱军, 骆楚君, 等. 射频消融术与胺碘酮比较治疗房颤的药物经济学评价. 中国循证医学杂志, 2015, 15(9):1018-1023.

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Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Radiofrequency Ablation versus Amiodarone for Atrial Fibrillation: A Meta-analysis

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