Cardiac ablation compared to drug therapy in the treatment of atrial fibrillation

a systematic review

Abstract

Objective: to evaluate differences in atrial fibrillation recurrence rates between patients undergoing catheter ablation and those receiving drug therapy.
Methods: systematic searches were conducted in PubMed and SciELO databases for clinical studies published between 2020-2024 evaluating symptomatic atrial fibrillation outcomes. The PICO strategy was implemented using MeSH descriptors with Boolean operators. Inclusion criteria comprised comparative studies between drug intervention and catheter ablation with recurrence as primary endpoint. Results: seven clinical studies were analyzed: three comparing radiofrequency ablation and four comparing cryoablation with class I and III antiarrhythmic agents. All studies demonstrated lower atrial fibrillation recurrence rates with ablation compared to pharmacological treatment. Catheter ablation showed superior efficacy in reducing atrial tachyarrhythmia recurrence, with success rates of 48-75% versus 30-45% for drug therapy. Cryoablation as initial therapy proved superior to antiarrhythmics in preventing
paroxysmal atrial fibrillation recurrence. Ablation demonstrated superior efficacy regardless of atrial fibrillation type, showing better symptomatic control
and quality of life across paroxysmal, persistent, and long-standing persistent categories. Patients undergoing ablation reported improved functional capacity and reduced symptom burden compared to pharmacological management alone. Conclusion: catheter ablation demonstrates superior efficiency in reducing symptoms and atrial fibrillation recurrence compared to pharmacological therapy, establishing it as the preferred therapeutic approach for appropriate candidates.