The trend of change in catheter ablation versus antiarrhythmic drugs for the management of atrial fibrillation over time: a meta-analysis and meta-regression

Objective To evaluate the trend of change in the efficacy and safety of catheter ablation compared with antiarrhythmic drug therapy (ADT) for rhythm control in patients with atrial fibrillation (AF) over time. Methods The online databases PubMed and EMBASE were searched for relevant studies. STATA software (version 12.0) was used to perform the meta-analysis and meta-regression. Results Fifteen randomized controlled trials including 2249 patients with AF were identified. The pooled results showed that catheter ablation was associated with a 52% reduction in the risk of AF recurrence compared with ADT [risk ratio (RR) = 0.48, 95% confidence interval (CI): 0.40-0.57, I2 = 70.7%). Subgroup analyses showed that catheter ablation exhibited less efficacy in studies after 2011 compared to studies before 2011 (RR = 0.61, 95% CI: 0.54-0.68, I2 = 9.3% and RR = 0.34, 95% CI: 0.24-0.47, I2 = 69.9%, respectively), and the safety outcome showed a 1.08-fold higher incidence of adverse events (14.2% vs. 7.3%; RR =1.08, 95% CI: 1.04-1.13) in studies after 2011. Conclusions Catheter ablation appears to be superior to ADT for rhythm control. However, less efficacy and a higher rate of adverse events were observed in studies after 2011 compared to studies before 2011.