For atrial fibrillation patients, how effective is the use of cardiac ablation compared to antiarrhythmic drugs?

Objectives--- to compare the effectiveness of cardiac ablation and antiarrhythmic drugs of atrial fibrillation (AF) patients for AF recurrence. The secondary outcomes are to compare cardiac ablation and antiarrhythmic drugs of AF patients for the quality of life and left ventricle ejection fraction. Background--- Atrial fibrillation is the most prevalent type of cardiovascular arrythmia worldwide. Most individuals with AF are treated with anti-arrhythmic drugs (AADs) to achieve rhythm control. However, adverse effects and the limited efficacy of available AADs make this method less than ideal for maintaining sinus rhythm. When AADs cannot restore and sustain sinus rhythm (SR), catheter ablation (CA) is usually performed. Design---Systematic review. Methods and Results--- Four databases were searched. The searched was limited to English language only. The Cochrane library was a tool for risk of bias assessment and quality for included studies. There were 17 RCTs met the inclusion criteria. Two of the studies were high risk for random sequence generation. All the studies favoured the ablation group. The risk ratio was 0.58, meaning the AF recurrence rate in the ablation group is 42% lower than in the drug group (95% CI 0.51 to 0.65, p< 0.00001). Conclusion--- The current evidence demonstrated that cardiac ablation is significantly lower than antiarrhythmic drugs for AF recurrence rate. Cardiac ablation is better than antiarrhythmic treatment for preventing AF recurrence.