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Volume 12
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10.3390/diagnostics12020433
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Systematic Review

Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials

by
Emmanouil Charitakis
1,*,
Silvia Metelli
2,
Lars O. Karlsson
1,
Antonios P. Antoniadis
3,
Ioan Liuba
1,
Henrik Almroth
1,
Anders Hassel Jönsson
1,
Jonas Schwieler
4,
Skevos Sideris
5,
Dimitrios Tsartsalis
6,
Elena Dragioti
7,8,
Nikolaos Fragakis
3 and
Anna Chaimani
2
1
Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden
2
Research Center of Epidemiology and Statistics (CRESS-U1153), INSERM, Université de Paris, 75004 Paris, France
3
3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, 54124 Thessaloniki, Greece
4
Heart and Vascular Theme, Karolinska University Hospital, 171 76 Stockholm, Sweden
5
Department of Cardiology, Hippokration Hospital, 11527 Athens, Greece
6
Department of Clinical Physiology, Linköping University Hospital, 581 85 Linköping, Sweden
7
Pain and Rehabilitation Centre, Linköping University Hospital, 581 85 Linköping, Sweden
8
Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden
*
Author to whom correspondence should be addressed.
Diagnostics 2022, 12(2), 433; https://doi.org/10.3390/diagnostics12020433
Submission received: 14 December 2021 / Revised: 14 January 2022 / Accepted: 29 January 2022 / Published: 9 February 2022
(This article belongs to the Special Issue Pathogenesis, Diagnosis and Management of Atrial Fibrillation)
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Abstract

Although catheter ablation (CA) is an established treatment for paroxysmal atrial fibrillation (PAF), there is no consensus regarding the most efficient CA strategy. The objective of this network meta-analysis (NMA) was to compare the efficacy and safety of different CA strategies for PAF. A systematic search was performed in PubMed, Web of Science, and CENTRAL until the final search date, 5 October 2020. Randomised controlled trials (RCT) comparing different CA strategies and methods for pulmonary vein isolation (PVI) were included. Efficacy was defined as lack of arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of six months. In total, 43 RCTs comparing 11 different CA strategies involving 6701 patients were included. The risk of recurrence was significantly decreased in comparison with PVI with radiofrequency only for the following treatments: PVI with adjuvant ablation (RR: 0.79, CI: 0.65–0.97) and PVI with sympathetic modulation (RR: 0.64, CI: 0.46–0.88). However, PVI with radiofrequency was superior to non-PVI strategies (RR: 1.65, CI: 1.2–2.26). No statistically significant difference was found in safety between different CA strategies. Concerning different PVI strategies, no difference was observed either in efficacy or in safety between tested strategies. This NMA suggests that different PVI strategies are generally similar in terms of efficacy, while PVI with additional ablation or sympathetic modulation may be more effective than PVI alone. This study provides decision-makers with insights into the efficacy and safety of different CA strategies.
Keywords: network meta-analysis; paroxysmal atrial fibrillation; catheter ablation; antiarrhythmic drugs network meta-analysis; paroxysmal atrial fibrillation; catheter ablation; antiarrhythmic drugs

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MDPI and ACS Style

Charitakis, E.; Metelli, S.; Karlsson, L.O.; Antoniadis, A.P.; Liuba, I.; Almroth, H.; Hassel Jönsson, A.; Schwieler, J.; Sideris, S.; Tsartsalis, D.; et al. Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials. Diagnostics 2022, 12, 433. https://doi.org/10.3390/diagnostics12020433

AMA Style

Charitakis E, Metelli S, Karlsson LO, Antoniadis AP, Liuba I, Almroth H, Hassel Jönsson A, Schwieler J, Sideris S, Tsartsalis D, et al. Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials. Diagnostics. 2022; 12(2):433. https://doi.org/10.3390/diagnostics12020433

Chicago/Turabian Style

Charitakis, Emmanouil, Silvia Metelli, Lars O. Karlsson, Antonios P. Antoniadis, Ioan Liuba, Henrik Almroth, Anders Hassel Jönsson, Jonas Schwieler, Skevos Sideris, Dimitrios Tsartsalis, and et al. 2022. "Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials" Diagnostics 12, no. 2: 433. https://doi.org/10.3390/diagnostics12020433

APA Style

Charitakis, E., Metelli, S., Karlsson, L. O., Antoniadis, A. P., Liuba, I., Almroth, H., Hassel Jönsson, A., Schwieler, J., Sideris, S., Tsartsalis, D., Dragioti, E., Fragakis, N., & Chaimani, A. (2022). Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials. Diagnostics, 12(2), 433. https://doi.org/10.3390/diagnostics12020433

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