Article Impact Level: HIGH Data Quality: STRONG Summary of Annals of Internal Medicine, ANNALS-25-00253. https://doi.org/10.7326/ANNALS-25-00253 Dr. Bryce Montané et al.
Points
- A comprehensive meta-analysis compared catheter and surgical ablation against medical therapy to assess key clinical outcomes like stroke, mortality, and heart failure hospitalization.
- Catheter ablation significantly reduced long-term ischemic stroke risk after 30 days, all-cause mortality, and subsequent hospitalization for heart failure compared to standard medical therapy.
- This procedure was associated with a substantially increased relative risk of ischemic stroke occurring within the first 30 days, negating some of its overall stroke benefits.
- Surgical ablation demonstrated a clear and statistically significant benefit by reducing the overall incidence of both ischemic stroke and stroke from any cause for the patient cohort.
- In contrast to its effect on stroke, surgical ablation showed no statistically significant benefit for reducing all-cause mortality or preventing future hospitalization due to heart failure.
Summary
A recent systematic review and meta-analysis of randomized controlled trials investigated the effect of ablation on clinical outcomes in patients with atrial fibrillation. The study compared catheter or surgical ablation against medical therapy, with a primary outcome of ischemic stroke occurring more than 30 days post-procedure. The analysis synthesized data from trials with at least one month of follow-up to evaluate the impact on ischemic stroke, all-cause mortality, and hospitalization for heart failure (HF).
The analysis demonstrated that catheter ablation, when compared to medical therapy, significantly reduced the long-term risk of ischemic stroke after 30 days (Relative Risk [RR], 0.63; 95% CI, 0.43 to 0.92). It also reduced all-cause mortality (RR, 0.73; 95% CI, 0.60-0.88) and hospitalizations for heart failure (RR, 0.68; 95% CI, 0.55-0.85). However, this benefit was offset by a substantially increased risk of periprocedural ischemic stroke within 30 days (RR, 6.81; 95% CI, 1.56 to 29.8). Consequently, the overall risk for any ischemic stroke (RR, 0.77; 95% CI, 0.55 to 1.09) and all-cause stroke (RR, 0.77; 95% CI, 0.57 to 1.05) did not reach statistical significance.
In contrast, surgical ablation was found to reduce the overall risks for both ischemic stroke (RR, 0.54; 95% CI, 0.34 to 0.86) and any-cause stroke (RR, 0.54; 95% CI, 0.35 to 0.82). However, its benefit for other outcomes remained uncertain. The analysis showed no statistically significant reduction in ischemic stroke after 30 days (RR, 0.63; 95% CI, 0.37 to 1.06), mortality (RR, 0.90; 95% CI, 0.70 to 1.15), or heart failure hospitalization (RR, 0.90; 95% CI, 0.60 to 1.35). The authors concluded that while catheter ablation offers broader benefits beyond 30 days, its periprocedural risk must be considered; in contrast, the primary benefit of surgical ablation appears to be confined to stroke reduction.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00253
References Montané, B., Zhang, S., Wolfe, J. D., Prime, S., Luo, C., Cooper, D. H., Doering, M., Blomstrom-Lundqvist, C., Nashef, S. A. M., Osmancik, P., Andrade, J. G., Bertaglia, E., Parkash, R., Mark, D. B., Nielsen, J. C., Sharples, L. D., & Gage, B. F. (2025). Catheter and surgical ablation for atrial fibrillation: A systematic review and meta-analysis. Annals of Internal Medicine, ANNALS-25-00253. https://doi.org/10.7326/ANNALS-25-00253
