Meta-analysis of the therapeutic effects of various methods for the treatment of chronic atrial fibrillation

The aim of this study was to analyze the therapeutic effects of various methods for the treatment of chronic atrial fibrillation (AF). Randomized controlled trials (RCT) concerning drug therapy and catheter ablation for the treatment of chronic AF were retrieved. The RevMan 5.1 software package was used for the meta-analysis. A total of 20 papers were assessed in this study. The results of the analysis indicated that the success rate was lower [odds ratio (OR), 8.94; 95% confidence interval (CI), 4.70–17.02; P<0.0001] and the relapse rate was higher (OR, 0.07, 95% CI, 0.05–0.10; P<0.0001) for drug therapy compared with that for catheter ablation. With regard to different catheter ablation procedures, the success rate for pulmonary vein antrum isolation (PVAI) was lower compared with that for PVAI plus complex fractionated atrial electrogram (CFAE; OR, 0.53; 95% CI, 0.37–0.78; P=0.0001). Pulmonary vein isolation (PVI) plus left atrial ablation (LAA) had a higher success rate compared with PVI alone (OR, 2.79; 95% CI, 1.59–4.88, P=0.0003). There was not identified to be a significant difference in the success rates between PVAI and CFAE (OR, 2.05; 95% CI, 0.06–205.74; P=0.76) or between PVI and circumferential pulmonary vein isolation (CPVI; OR, 0.94; 95% CI, 0.29–3.00; P=0.91). All the funnel plots of publication bias were essentially symmetrical. In conclusion, the success rate was higher and the relapse rate was lower for catheter ablation compared with drug therapy. Among the different procedures of catheter ablation, there were no significant differences in success rate between two single procedures; however, the success rates were higher for the combined methods compared with those for the single methods.