Arrhythmias & electrophysiologyMeta-analysis
Antiarrhythmic drugs vs catheter ablation as rhythm control for atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials
- systematic review
- update of a National Institute for Health and Care Excellence (2021) systematic review
- Cochrane Risk of Bias 2 tool
- GRADE approach
Authors' conclusion
This review found that, in some subgroups of patients, catheter ablation was better than AAD treatment when considering AF recurrence and mortality. However, catheter ablation has rare but serious complications that should be considered when making informed treatment decisions.
Study context
- Population
- Patients with atrial fibrillation (AF) treated for rhythm control22 studies (31 references) included in the review
- Comparison
- treated with anti-arrhythmic drugs (AAD) compared with catheter ablation
Pooled result
As reported in the abstract
Recurrence of AF
AAD vs catheter ablationRelative risk (95% CI)
treatment-naïve paroxysmal AF
1.76(1.34–2.32)
AAD-exposed persistent AF
1.62(1.40–1.87)
paroxysmal AF previously exposed to catheter ablation
2.12(1.61–2.80)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| All-cause mortality — AAD vs catheter ablation · paroxysmal AF | 1.79 (0.80–4.02) | |
| All-cause mortality — AAD vs catheter ablation · persistent AF | 1.45 (0.56–3.75) | |
| 0.20.5125Relative risk (log scale) |
Safety
| Outcome | AAD | catheter ablation |
|---|---|---|
| Medication side effects, including gastrointestinal symptoms and syncope | incidence between 0.8 and 3% | Not reported in the abstract |
- Catheter ablation complications, such as pericardial tamponade and phrenic nerve paralysis
- between 0.3 and 2.5% · incidence
Original publication
Antiarrhythmic drugs vs catheter ablation as rhythm control for atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials. Heart Rhythm. Published 23 March 2026. doi:10.1016/j.hrthm.2026.03.1886
Summarised from the published abstract; every number is checked against it