A systematic review of surgical ablation versus catheter ablation for atrial fibrillation

Katherine Kearney, Rowan Stephenson, Kevin Phan, Wei Yen Chan, Min Yin Huang, Tristan D Yan

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Atrial fibrillation (AF) is an increasingly prevalent condition in the ageing population, with significantly associated morbidity and mortality. Surgical and catheter ablative strategies both aim to reduce mortality and morbidity through freedom from AF. This review consolidates all currently available comparative data to evaluate these two interventions.

METHODS: A systematic search was conducted across MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews from January 2000 until August 2013. All studies were critically appraised and only those directly comparing surgical and catheter ablation were included.

RESULTS: Seven studies were deemed suitable for analysis according to the inclusion criteria. Freedom from AF was significantly higher in the surgical ablation group versus the catheter ablation group at 6-month, 12-month and study endpoint follow-up periods. Subgroup analysis demonstrated similar trends, with higher freedom from AF in the surgical ablation group for paroxysmal AF patients. The incidence of pacemaker implantation was higher, while no difference in stroke or cardiac tamponade was demonstrated for the surgical versus catheter ablation groups.

CONCLUSIONS: Current evidence suggests that epicardial ablative strategies are associated with higher freedom from AF, higher pacemaker implantation rates and comparable neurological complications and cardiac tamponade incidence to catheter ablative treatment. Other complications and risks were poorly reported, which warrants further randomized controlled trials (RCTs) of adequate power and follow-up duration.

Original languageEnglish
Pages (from-to)15-29
Number of pages15
JournalAnnals of Cardiothoracic Surgery
Volume3
Issue number1
DOIs
Publication statusPublished - Jan 2014

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Keywords

  • Journal Article
  • Review

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