Table 2.
Randomised controlled trials comparing efficacy of catheter ablation versus medical therapy for prevention of recurrent atrial fibrillation
| Study | No | Single or multicentre trial | Pulmonary vein isolation technique | Primary control group therapy (%) | Type of atrial fibrillation (%) | Ablation as first line therapy? | Rhythm monitoring* | Follow-up (years) | Freedom from recurrent atrial tachyarrhythmia | Overall frequency of major complications with ablation (%)† | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Ablation | Medical | ||||||||||
| Krittayaphong et al 200331 | 30 | Single | SOA | Amiodarone (100) | Paroxysmal (70), persistent (30) | No | Periodic Holter monitoring | 1 | 79 | 40 | 7 |
| Wazni et al 200527 | 70 | Multicentre | SOA | Flecainide (77), sotalol (23) | Paroxysmal (96), persistent (4) | Yes | Daily brief event monitoring during first and third months, and periodic Holter monitoring | 1 | 87 | 37 | 3 |
| Oral et al 200632 | 146 | Multicentre | CPVA | Amiodarone and up to two electrical cardioversions within three months of randomisation | Persistent or permanent (100) | No | Daily brief event monitoring | 1 | 74 | 58 | 0 |
| Stabile et al 200628‡ | 137 | Multicentre | CPVA | Amiodarone (62), flecainide (26), propafenone (10), disopyramide (2), sotalol (6)§ | Paroxysmal (67), persistent (33) | No | Daily brief event monitoring during first three months, and periodic Holter monitoring | 1 | 56 | 9 | 4 |
| Pappone et al 200629 | 198 | Single | CPVA | Amiodarone (33), flecainide (33), sotalol (33)§ | Paroxysmal (100) | No | Daily brief event monitoring, and periodic Holter monitoring | 1 | 86 | 22 | 1 |
| Jais et al 200630 | 112 | Multicentre | SOA | §¶ | Paroxysmal (100) | No | Periodic Holter monitoring | 1 | 75 | 6 | 4 |
CPVA=circumferential pulmonary vein ablation; SOA=segmental ostial ablation.
*Includes assessment at routine clinic appointments.
†Includes death, cardiac tamponade, transient ischaemic attack or stroke, symptomatic or >50% pulmonary vein stenosis, atrio-oesophageal perforation, vascular complications, or phrenic nerve injury.
‡According to study protocol, patients treated with catheter ablation also received antiarrhythmic drug therapy.
§Various combinations of antiarrhythmic drugs were used.
¶Not specified but 88 class I, 39 class II, 59 class III, and 6 class IV agents were used.