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Cryoablation versus Antiarrhythmic therapy for initial treatment of Atrial Fibrillation: A Systematic Review and Meta-Analysis.
  • Mitra Patel,
  • Khalid Changal,
  • Neha Patel
Mitra Patel
University of Toledo College of Medicine

Corresponding Author:[email protected]

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Khalid Changal
University of Toledo College of Medicine
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Neha Patel
University of Toledo College of Medicine
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Abstract

Guidelines suggest the use of antiarrhythmic agents as initial therapy in patients with paroxysmal atrial fibrillation, however using cryoballoon ablation as a first line therapy might have increased efficacy. The safety and efficacy of cryoballoon ablation as an initial therapy has not yet been established. A comprehensive search of multiple databases was performed to find randomized control trials (RCT) that directly compared cryoablation therapy versus antiarrhythmic therapy as initial treatment for patients with atrial fibrillation. A total of three RCTs met the inclusion criteria (724 patients) and were used in the meta-analysis. The primary outcome of our meta-analysis was recurrence of atrial tachyarrhythmias. The secondary outcome evaluated serious adverse events of each therapy. The results showed a statistically significant reduction of recurrence of atrial tachyarrhythmic events in patients receiving cryoballoon ablation compared to antiarrhythmic therapy [Risk Ratio (RR): 0.60, 95% CI (0.49, 0.72), P<0.00001, I2 = 0%]. There was no significant difference in serious adverse events between patients receiving cryoballoon ablation compared to patients receiving antiarrhythmic therapy. [Risk Ratio (RR): 1.19, 95% CI (0.71, 2.00), P=0.52, I2 = 0%]. Our meta-analysis showed that cryoballoon ablation as an initial therapy is more efficacious than drug therapy with antiarrhythmics in patients with atrial fibrillation without an increased risk of serious adverse events. Keywords: Cryoablation, antiarrhythmics, atrial fibrillation, conduction disturbance, meta-analysis.