Catheter Ablation vs. Medical Therapy as First-line for Treatment of Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review

Introduction: The outcomes of Catheter Ablation (CA) and antiarrhythmic drugs (AAD) as the first-line treatment of paroxysmal Atrial Fibrillation (AF) are unclear. The current systematic review reports the evidence on efficacy outcomes of Radiofrequency Ablation (RFA) versus antiarrhythmic drugs (AAD) among these patients. Methods: Three databases, including PubMed, Cochrane, and Google Scholar, were searched by three independent reviewers to identify relevant randomized control trials (RCTs). Results: A total of 1,145 patients across five studies were assessed in this systematic review. Among these patients, 577 were randomized to receive ablation, and 568 were randomized to receive AAD. The recurrence rate was significantly higher among patients who received AAD at 1-year and 2-year follow-ups. The health-related quality of life (HR-QoL) was significantly better in the patients who received ablation therapy. The incidence of serious adverse events was 14 (6.4%) in the ablation group and 9 (4.3%) in the AAD group. Conclusion: CA seems promising for managing AF in terms of any AF recurrence, hospitalization, and quality of life. There was no increase in side effects compared to AAD.