Systematic review and network meta‐analysis of atrial fibrillation percutaneous catheter ablation technologies using randomized controlled trials

Abstract

Aims We sought out to make comparisons between all atrial fibrillation (AF) catheter ablation technologies using randomised controlled trial data. Our comparisons were freedom from AF, procedural duration and fluoroscopy duration. Methods Searches were made of EMBASE, MEDLINE and CENTRAL databases and studies were selected which had Cryoballoon, conventional radiofrequency (RF), multipolar radiofrequency catheters and Laser technology as an arm in the study and were identified as randomised controlled trials (RCT). These studies were analysed for direct comparisons using conventional meta‐analysis and a combination of indirect and direct comparisons via a network meta‐analysis (NMA). Results With respect to freedom from AF both direct comparisons and NMA did not demonstrate any significant difference. However in analysis of procedural and fluoroscopy duration (minutes) for the pulmonary vein ablation catheter (PVAC), both conventional analysis and NMA revealed significantly shorter procedure times, RF vs PVAC (Conv: 61.99 [38.03 – 85.94], P < 0.00001, NMA: 54.76 [36.64 – 72.88], P< 0.0001) and fluoroscopy times, RF vs PVAC (Conv: 12.96 [6.40 – 19.53], P = 0.0001, NMA: 8.89 [3.27 – 14.51], P<0.01). Procedural duration was also shorter for the Cryoballoon with NMA, RF vs CRYO (20.56 [3.47 – 37.65], P = 0.02). Discussion Our analysis demonstrated that whilst there was no difference in the efficacy of the individual catheter technologies, there are significant differences in the procedural duration for the PVAC and the Cryoballoon. Whilst they may seem an attractive solution for high volume centres, further RCTs of next generation technologies should be examined.