Arrhythmias & electrophysiology
CATHETER ABLATION VERSUS SHAM FOR SYMPTOMATIC ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND BAYESIAN META-ANALYSIS OF RANDOMIZED TRIALS
Authors' conclusion
Compared with sham embedded in active rhythm control, catheter ablation reduces AF recurrence and burden and has a high probability of clinically important QoL benefit, although its magnitude remains uncertain. Trials differ in population, monitoring, and estimator, not direction of effect.
Study context
- Population
- Patients with symptomatic atrial fibrillation (AF) in randomized trials of catheter ablation versus shamFour trials eligible, three (448 patients) pooled
- Participants
- 468 patients
- Comparison
- Catheter ablation versus sham in symptomatic AF
- Outcome
- Between-group difference in AFEQT score
Methodological detailsBayesian random-effects model, GRADE certainty rating
- Bayesian random-effects model
- GRADE certainty rating
Pooled result
As reported in the abstract
Difference in AFEQT score (improvement with ablation)
13.5 points
95% CrI 1.6–26.9
credible interval; posterior probability of benefit 0.98, of exceeding the 5-point MCID 0.94
Difference in AFEQT score (improvement with ablation), PVI-SHAM-AF's primary estimator
12.9 points
CI −0.4 to 27.1
probability 0.97 and 0.91
Difference in AFEQT score, without PVI-SHAM-AF (improvement with ablation)
18.9 points
CI 6.7–31.4
Ablation improved AFEQT relative to sham
Further pooled results
| Outcome | Pooled risk ratio (CrI) | |
|---|---|---|
| AF recurrenceCredible interval; reduced in every trial | 0.49 (0.17–0.89) | |
| 0.10.31310Pooled risk ratio (log scale) |
Certainty of evidence (GRADE)
- Moderate for AF burden and recurrence
- Low for quality of life (QoL)
Original publication
Summarised from the published abstract; every number is checked against it