Academic Editors: Yoshiaki Kaneko and Peter A. McCullough
Background: Catheter ablation is an effective treatment for
atrial fibrillation (AF), primarily performed in patients who fail antiarrhythmic
drugs. Whether early catheter ablation, as first-line therapy, is associated with
improved clinical outcomes remains unclear. Methods: Electronic
databases (PubMed, Scopus, Embase) were searched until March 28th, 2021.
Randomized controlled trials (RCTs) compared catheter ablation vs antiarrhythmic
drug therapy as first-line therapy were included. The primary outcome of interest
was the first documented recurrence of any atrial tachyarrhythmia (symptomatic or
asymptomatic; AF, atrial flutter, and atrial tachycardia). Secondary outcomes
included symptomatic atrial tachyarrhythmia (AF, atrial flutter, and atrial
tachycardia) and serious adverse events. Unadjusted risk ratios (RR) were
calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with
statistical significance considered if the confidence interval (CI) excludes one
and p