Quality of Life and Safety Outcomes after First-Line Treatment of Symptomatic AF with Cryoablation or Drug Therapy: A Meta-Analysis of Randomized Controlled Trials

TL;DR

Cryoablation improves quality of life and safety outcomes compared to drug therapy for patients with symptomatic atrial fibrillation.

Contribution

This study is the first meta-analysis comparing cryoablation and drug therapy as first-line treatments for symptomatic AF, focusing on quality of life and safety outcomes.

Findings

Cryoablation significantly improves AF-specific quality of life scores compared to antiarrhythmic drugs.

Cryoablation is associated with fewer serious adverse events and hospitalizations than drug therapy.

There is no significant difference in major cardiovascular events or emergency department visits between the two treatments.

Abstract

Cryoablation has emerged as a recognized interventional
strategy for the treatment of atrial fibrillation (AF). Numerous trials have
investigated cryoablation as a first-line therapy for AF. This meta-analysis
aimed to evaluate the impact of cryoablation on quality of life (QoL) and safety
outcomes compared to antiarrhythmic drugs (AADs) in patients with symptomatic AF.

A comprehensive search of the PubMed, EMBASE, and Cochrane
Library databases was conducted for randomized controlled trials (RCTs) comparing
cryoablation and AADs as first-line treatments for AF until May 2023. Continuous
outcome data were analyzed using mean differences (MDs) with 95% confidence
intervals (CIs), and dichotomous outcome data were analyzed using relative risks
(RRs) with 95% CIs. The primary outcomes assessed were QoL and serious adverse
events.

Our analysis included four RCTs involving 928 patients.
Cryoablation was associated with a significant improvement in the AF Effect on
Quality of Life (AFEQT) score (3 trials; MD 7.46, 95% CI 2.50 to 12.42;
p = 0.003; I2 = 79%) and EQ-VAS score (2 trials; MD 1.49, 95% CI
1.13 to 1.86; p
< 0.001; I2 = 0%) compared to AAD therapy.
Additionally, cryoablation demonstrated a modest increase in EQ-5D score from
baseline compared to AAD therapy, with no statistically significance (2 trials;
MD 0.03, 95% CI –0.01 to 0.07; p = 0.07; I2 = 79%). Furthermore,
the rate of serious adverse events was significantly lower with cryoablation
compared to AAD therapy (4 trials; 11.8% vs. 16.3%; RR, 0.73; 95% CI,
0.54–1.00; p = 0.05; I2 = 0%). Cryoablation was also associated
with a reduction in overall adverse events, incidence of persistent AF,
hospitalizations, and additional ablation. However, there was no significant
difference in major adverse cardiovascular events and emergency department visits
between the two treatment groups.

Cryoablation, as a
first-line treatment for symptomatic AF patients, significantly improved
AF-specific quality of life and reduced serious adverse events, as well as
overall adverse events, persistent AF, hospitalizations, and additional ablation
compared to AADs.

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