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A Systematic Review

Amit Noheria, MBBS, SM; Abhishek Kumar, MBBS, MPH; John V. Wylie Jr, MD; Mark E. Josephson, MD

Arch Intern Med. 2008;168(6):581-586.

Background  Circumferential pulmonary vein ablation (CPVA) has become common therapy for atrial fibrillation (AF), but results of large randomized controlled trials comparing this procedure with antiarrhythmic drug therapy (ADT) have not been published to date. We conducted a systematic literature review to assess whether CPVA is superior to ADT for the management of AF.

Methods  We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant randomized controlled trials. Data were abstracted to construct a 2 x 2 table for each trial. Recurrence of any atrial tachyarrhythmia (AT) was considered the primary end point of the trials. The estimate and confidence interval for the pooled risk ratio of AT recurrence–free survival in the CPVA group vs the ADT group were obtained using the random-effects model.

Results  Four trials qualified for the meta-analysis. In total, 162 of 214 patients (75.7%) in the CPVA group had AT recurrence–free survival vs 41 of 218 patients (18.8%) in the ADT group. The random-effects pooled risk ratio for AT recurrence–free survival was 3.73 (95% confidence interval, 2.47-5.63). In addition, fewer adverse events were reported in the CPVA group compared with that in the ADT group.

Conclusions  We observed statistically significantly better AT recurrence–free survival with CPVA than with ADT. These results highlight the need for larger trials to determine the appropriate role for CPVA in the management of AF. Ongoing clinical trials may provide further guidance on these treatment options for AF.

Author Affiliations: Department of Epidemiology, Harvard School of Public Health (Drs Noheria and Kumar), and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School (Drs Wylie and Josephson), Boston, Massachusetts. Dr Noheria is now with the Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.

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