Comparing energy sources for surgical ablation of atrial fibrillation

a Bayesian network meta-analysis of randomized, controlled trials

Kevin Phan, Ashleigh Xie, Narendra Kumar, Sophia Wong, Caroline Medi, Mark La Meir, Tristan D. Yan*

*Corresponding author for this work

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Simplified maze procedures involving radiofrequency, cryoenergy and microwave energy sources have been increasingly utilized for surgical treatment of atrial fibrillation as an alternative to the traditional cut-and-sew approach. In the absence of direct comparisons, a Bayesian network meta-analysis is another alternative to assess the relative effect of different treatments, using indirect evidence. A Bayesian meta-analysis of indirect evidence was performed using 16 published randomized trials identified from 6 databases. Rank probability analysis was used to rank each intervention in terms of their probability of having the best outcome. Sinus rhythm prevalence beyond the 12-month follow-up was similar between the cut-and-sew, microwave and radiofrequency approaches, which were all ranked better than cryoablation (respectively, 39, 36, and 25 vs 1%). The cut-and-sew maze was ranked worst in terms of mortality outcomes compared with microwave, radiofrequency and cryoenergy (2 vs 19, 34, and 24%, respectively). The cut-and-sew maze procedure was associated with significantly lower stroke rates compared with microwave ablation [odds ratio < 0.01; 95% confidence interval 0.00, 0.82], and ranked the best in terms of pacemaker requirements compared with microwave, radiofrequency and cryoenergy (81 vs 14, and 1, < 0.01% respectively). Bayesian rank probability analysis shows that the cut-and-sew approach is associated with the best outcomes in terms of sinus rhythm prevalence and stroke outcomes, and remains the gold standard approach for AF treatment. Given the limitations of indirect comparison analysis, these results should be viewed with caution and not over-interpreted.

Original languageEnglish
Article numberezu408
Pages (from-to)201-211
Number of pages11
JournalEuropean Journal of Cardio-thoracic Surgery
Volume48
Issue number2
DOIs
Publication statusPublished - 1 Aug 2015

Fingerprint Dive into the research topics of 'Comparing energy sources for surgical ablation of atrial fibrillation: a Bayesian network meta-analysis of randomized, controlled trials'. Together they form a unique fingerprint.

  • Cite this