Can J Cardiol. 2025 Oct 23:S0828-282X(25)01275-9. doi: 10.1016/j.cjca.2025.10.018. Online ahead of print.
ABSTRACT
BACKGROUND: Ablation procedures for atrial fibrillation (AF), including catheter (CA) and surgical ablation, are effective rhythm control therapies. The current study is a Bayesian network meta-analysis evaluating randomized evidence on the invasive treatment of AF, focusing on freedom from atrial tachyarrhythmias (ATA), while evaluating the potential trade-off in morbidity and mortality.
METHODS: This study was registered in PROSPERO (CRD42025632171). Randomized controlled trials (RCTs) were included comparing any of the four treatments; CA, isolated thoracoscopic, hybrid thoracoscopic ablation, and the Convergent procedure. Primary outcome was freedom from ATA at 12-months. Secondary outcomes were mortality, stroke, and bleeding. A Bayesian network meta-analysis was performed. The combined effects of the primary and secondary outcomes were studied in a bivariate analysis. Treatments were ranked and their effects were summarized using surface under the cumulative ranking curves (SUCRAs).
RESULTS: Ten RCTs were included in the analysis (n=877 patients, predominantly persistent AF). Using CA as a reference, the pooled network ORs for freedom from ATA for hybrid thoracoscopic, isolated thoracoscopic, and Convergent were 4.95 (95%CrI 2.16-13.46), 2.23 (95%CrI 1.23-4.48), and 2.23 (95%CrI 0.90-6.69), with SUCRAs for hybrid thoracoscopic, isolated thoracoscopic, Convergent, and CA of 95.5%, 50.8%, 52.1%, and 1.5%, respectively. No increase in periprocedural morbidity or mortality was observed. Results were robust across various sensitivity analyses.
CONCLUSION: In this Bayesian network meta-analysis, consisting exclusively of randomized data, surgical ablation in general, but hybrid ablation in particular, provides superior outcome in terms one-year-freedom from ATA. Both CA and surgical procedures are characterized by a favorable safety profile.
PMID:41139022 | DOI:10.1016/j.cjca.2025.10.018
