Catheter Ablation for Treatment of Atrial Fibrillation [Prospectively Entered]

Project Summary Title and Description

Title
Catheter Ablation for Treatment of Atrial Fibrillation [Prospectively Entered]
Description
Because catheter ablation is increasingly being used to treat AF patients in the Medicare population, and there is uncertainty regarding the efficacy and harms of this procedure in this population in particular, a systematic review to re-evaluate the current state of evidence, identify and evaluate inconsistencies in the evidence, and identify important research gaps is warranted to help inform clinical practice and policy.
Attribution
N/A
Authors of Report
N/A
Methodology description
Using predefined criteria, randomized trials and observational studies comparing the efficacy, effectiveness, or safety of catheter ablation (radiofrequency or cryoballoon ablation) to medical therapy in patients with atrial fibrillation were included. Analyses were stratified by type of atrial fibrillation and length of followup (>12 months vs. ≤12 months). The quality of included studies was assessed, data were extracted, results were summarized qualitatively and using meta-analysis, and the strength of the evidence was graded for each primary outcome.
PROSPERO
CRD42014010331
DOI
10.7301/Z0BZ63ZW
Notes
N/A
Funding Source
Agency for Healthcare Research and Quality (AHRQ). Prepared by the Pacific Nortwest Evidence-based Practice Center under Contract No. HHSA 290-2012-00014-I. The Technology Assessment is available at: http://www.cms.gov/Medicare/Coverage/DeterminationProce

Key Questions

1. Key Question 1a. What is the comparative efficacy and effectiveness of AF catheter ablation on short- (6-12 months) and long- (>12 months) term outcomes in the general adult and Medicare populations? Comparison of interest : a) Catheter ablation compared with medical therapy
2. Key Question 2a. What are the comparative short- and long-term complications and harms (e.g., periprocedural or device-related harms) associated with AF catheter ablation in the general adult and Medicare populations? Comparison of interest: a) Catheter ablation compared with medical therapy
3. Key Question 3a. Are there modifications of efficacy, effectiveness, or harms of catheter ablation by patient-level characteristics such as age, sex, type of AF, comorbidities, risk for stroke or bleeding events, condition (i.e., patients with significant left ventricular dysfunction/heart failure or patients with significant left atrial enlargement or left ventricular hypertrophy), provider/setting characteristics or technique/approach? Comparison of interest: a) Catheter ablation compared with medical therapy
4. Key Question 1b. What is the comparative efficacy and effectiveness of AF catheter ablation on short- (6-12 months) and long- (>12 months) term outcomes in the general adult and Medicare populations? Comparison of interest: b) Comparing ablation using different energy sources
5. Key Question 2b. What are the comparative short- and long-term complications and harms (e.g., periprocedural or device-related harms) associated with AF catheter ablation in the general adult and Medicare populations? Comparison of interest: b) Comparing ablation using different energy sources
6. Key Question 3b. Are there modifications of efficacy, effectiveness, or harms of catheter ablation by patient-level characteristics such as age, sex, type of AF, comorbidities, risk for stroke or bleeding events, condition (i.e., patients with significant left ventricular dysfunction/heart failure or patients with significant left atrial enlargement or left ventricular hypertrophy), provider/setting characteristics or technique/approach? Comparison of interest: b) Comparing ablation using different energy sources
7. Key Question 2c. What are the short- and long-term complications and harms (e.g., periprocedural or device-related harms) associated with AF catheter ablation in the general adult and Medicare populations? Include case series only.

Associated Extraction Forms

Associated Studies (each link opens a new tab)

TitleAuthorsYear
Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy.2009
Circumferential pulmonary-vein ablation for chronic atrial fibrillation.2006
Pericardial effusion in atrial fibrillation ablation: a comparison between cryoballoon and radiofrequency pulmonary vein isolation.2010
Long-term efficacy and safety of two different rhythm control strategies in elderly patients with symptomatic persistent atrial fibrillation.2013
A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure.2013
Catheter ablation vs. amiodarone plus losartan for prevention of atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation.2009
Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study.2008
A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study.2006
Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial.2014
Radiofrequency catheter ablation and antiarrhythmic drug therapy: a prospective, randomized, 4-year follow-up trial: the APAF study.2011
Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation.2012
Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial.2010
Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study).2014
Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study).2006
Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial.2005
Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: a randomised controlled trial.2011
Role of anticoagulation therapy after pulmonary vein antrum isolation for atrial fibrillation treatment.2008
Pulmonary vein antrum isolation, atrioventricular junction ablation, and antiarrhythmic drugs combined with direct current cardioversion: survival rates at 7 years follow-up.2009
Effect of anxiety and depression on the recurrence of paroxysmal atrial fibrillation after circumferential pulmonary vein ablation.2012
Depression, anxiety, and quality of life after catheter ablation in patients with paroxysmal atrial fibrillation.2013
Mesh ablator vs. cryoballoon pulmonary vein ablation of symptomatic paroxysmal atrial fibrillation: results of the MACPAF study.2012
Comparison of effects on coagulation and inflammatory markers using a duty-cycled bipolar and unipolar radiofrequency pulmonary vein ablation catheter vs. a cryoballoon catheter for pulmonary vein isolation.2013
Early experience with the cryoablation balloon procedure for the treatment of atrial fibrillation by an experienced radiofrequency catheter ablation center.2013
Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial.2013
Stiff left atrial syndrome after catheter ablation for atrial fibrillation: clinical characterization, prevalence, and predictors.2011
Prevalence and predictors of complications of radiofrequency catheter ablation for atrial fibrillation.2011
Complications arising from catheter ablation of atrial fibrillation: temporal trends and predictors.2011
Maintenance of sinus rhythm with an ablation strategy in patients with atrial fibrillation is associated with a lower risk of stroke and death.2012
Outcomes of Medicare beneficiaries undergoing catheter ablation for atrial fibrillation.2012
Early complications of pulmonary vein catheter ablation for atrial fibrillation: a multicenter prospective registry on procedural safety.2007
Incidence and predictors of major complications from contemporary catheter ablation to treat cardiac arrhythmias.2011
Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation.2011
Complications of atrial fibrillation ablation in a high-volume center in 1,000 procedures: still cause for concern?2009
In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures.2013
Phrenic nerve injury after atrial fibrillation catheter ablation: characterization and outcome in a multicenter study.2006
Procedural complications, rehospitalizations, and repeat procedures after catheter ablation for atrial fibrillation.2012
Health outcomes with catheter ablation or antiarrhythmic drug therapy in atrial fibrillation: results of a propensity-matched analysis.2012
Acute safety outcomes in younger and older patients with atrial fibrillation treated with catheter ablation.2012
Long-term comparison of cryoballoon and radiofrequency ablation of paroxysmal atrial fibrillation: a propensity score matched analysis.
A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial).2014
Pulmonary venous isolation by antral ablation with a large cryoballoon for treatment of paroxysmal and persistent atrial fibrillation: medium-term outcomes and non-randomised comparison with pulmonary venous isolation by radiofrequency ablation.2010
Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?: a meta-analysis.2013
Comparison of pulmonary vein isolation using cryoballoon versus conventional radiofrequency for paroxysmal atrial fibrillation.2014
Early cerebral thromboembolic complications after radiofrequency catheter ablation of atrial fibrillation: incidence, characteristics, and risk factors.
Effects of sex on the incidence of cardiac tamponade after catheter ablation of atrial fibrillation: results from a worldwide survey in 34 943 atrial fibrillation ablation procedures.2014
Risk predictors of stroke and mortality after ablation for atrial fibrillation: the California experience 2005-2009.2014
Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in the elderly.2008
Cryoballoon versus RF ablation in paroxysmal atrial fibrillation: results from the German Ablation Registry.2014
Cellular damage, platelet activation, and inflammatory response after pulmonary vein isolation: a randomized study comparing radiofrequency ablation with cryoablation.2012
The COR trial: a randomized study with continuous rhythm monitoring to compare the efficacy of cryoenergy and radiofrequency for pulmonary vein isolation.2014

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