Comparison between surgical and catheter based ablation in atrial fibrillation, should surgical based ablation be implemented as first line? - A meta-analysis of studies

INTRODUCTION: Ablation remains a modality of choice in select patients with Atrial fibrillation (AF). Which is done via a surgical or catheter-based approach. OBJECTIVE: This meta-analysis aimed to compare the efficacy of Surgical and Catheter ablation in the management of AF. METHODS: Electronic search on PubMed (MEDLINE), EBSCO, EuropePMC, Clinicaltrials.gov, and Google Scholar was done. Studies comparing the use of surgical or catheter ablation in patients with AF were included. The Primary outcome of interest was Arrhythmia free patients at 12 months post-ablation. RESULTS: Eight studies (744 patients) reported a statistically significant difference in Arrhythmia recurrence rate between surgical and catheter-based ablation. The pooled hazard ratio was chosen to compare the risk of AF recurrence between these groups with pooled Hazard ratio comparing surgical to catheter approach of 0.40 [0.35,0.45], p < 0.001 favoring surgical approach; low heterogeneity I(2) 22%, p = 0.25. Meta-analyses were also performed on procedural time, length of stay and major adverse events. CONCLUSION: The increased rate of adverse effects and length of hospitalization impedes the implementation of surgical ablation as primary ablation method of AF in general. However, the result of our meta-analysis shows the promising result of surgical ablation compared to catheter-based ablation.