Ablation and pacing therapy improves a broad range of clinical outcomes for patients with medically refractory atrial fibrillation

Hildick-Smith, David

Cardiac Unit; Papworth Hospital, UK

Abstracted from:Wood MA, Brown-Mahoney C, Kay GN, Ellenbogen KA. Clinical outcomes after ablation and pacing therapy for atrial fibrillation: A meta-analysis. Circulation 2000; 101: 1138-1144 .

Evidence-based Healthcare 4(3):p 69, September 2000.

BACKGROUND

Atrial fibrillation (AF) causes a persistent irregularity of the heartbeat and has a high prevalence. About 10% of cases are not amenable to treating with drugs. In these cases, radiofrequency ablation of the atrioventricular (AV) node followed by permanent pacemaker insertion may relieve symptoms which impair quality of life.

OBJECTIVE

To clarify clinical outcomes and survival after ablation and pacing therapy for atrial fibrillation.

METHOD

Systematic review of any study.

FUNDING SOURCE

Medtronic, Inc.

LITERATURE REVIEW

(i) MEDLINE (January 1989-June 1998). (ii) Authors' knowledge of the literature. (iii) Review of references of relevant studies and manual library searches.

INCLUSION CRITERIA

1. Peer-reviewed, full length articles published in English.

2. Use of radiofrequency catheter ablation in medically refractory atrial tachyarrhythmia.

3. Numeric representation of measures of clinical outcome.

DATA EXTRACTION AND SYNTHESIS

No details provided on method of data extraction. Meta-analysis performed. Nineteen measures of outcome used (encompassing quality of life, ventricular function, exercise duration, and health-care use). Before-after changes in outcomes were generally considered, but only in patients receiving the treatment of interest.

MAIN RESULTS

The meta-analysis included 21 studies with a total of 1181 patients. Most studies were small and lacked a control group. The meta-analysis found significant improvement after ablation and pacing for most outcome measures. The calculated 1-year total and sudden death mortality rates after ablation and pacing therapy were 6.3% (95% CI 5.5-7.2%) and 2.0% (95% CI 1.5-2.6%), respectively.

AUTHORS' CONCLUSIONS

Ablation and pacing improves a broad range of clinical outcomes for patients with medically refractory atrial fibrillation. The calculated 1-year mortality rates after this therapy are low and comparable with medical therapy.