Comparison of catheter and surgical ablation of atrial fibrillation: A systemic review and meta-analysis of randomized trials

Objective To compare both the beneficial and adverse effects of catheter ablation (CA) and surgical ablation (SA) on patients with atrial fibrillation (AF). Methods We searched MEDLINE and 4 additional databases for randomized controlled trials that compared CA with SA. Following data extraction, we conducted a meta-analysis to estimate the efficacy and safety of CA relative to SA. The primary end point of this study was the absence of AF during a 12-month follow-up period without the use of antiarrhythmic drugs. Results Seven trials comparing SA with CA met the inclusion criteria for efficacy outcome assessments. Following the meta-analysis, we obtained a summary odds ratio (OR) of achieving success 1 year after CA relative to SA was 0.37:1 (95% confidence interval [CI], 0.20-0.69). The result was robust in the subgroup analysis. CA was associated with a greater incidence of femoral vascular complications (OR, 5.81; 95% CI, 1.03-32.71), but a lower incidence of pneumothorax (OR, 0.09; 95% CI, 0.01-0.74) than SA. Statistically significant differences in the other safety outcomes were not observed between CA and SA. Conclusions SA confers a moderate advantage over CA in 1-year efficacy outcomes and may be safely performed by experienced surgeons.