TDNet Discover

Background: Atrial Fibrillation (AF) is a major medical condition that affects millions of people. The standard for AF treatment in the past has been pharmacologic management. We have done an evidence-based clinical review (EBCR) to help answer the question of if catheter ablation is more effective as a first line therapy for AF management rather than the current pharmacologic standard of care. Purpose: The research aims to discover if CA is a superior form of treatment for longstanding AF using multiple parameters to measure patient outcomes. Methods: The researchers used multiple databases to find three finalized articles that best represented the various patient outcomes for CA versus pharmacologic management for AF. The researchers utilized the Critical Appraisal Skills Programme (CASP) assessment tool to determine the quality of the paper. The researchers then gave all studies a score of good, fair, or poor. Using these parameters the researchers finalized the research by agreeing on three papers to include in the final EBCR. The endpoints that were analyzed in this EBCR were, stroke/transient ischemic attack (TIA) occurrence, left ventricular ejection fraction (LVEF), arrhythmia recurrence, patients needing subsequent cardioversion, medication complications, hospitalizations, quality of life (QoL), and adverse events. All endpoints were compared between patients that received CA and patients that received pharmacologic therapy for AF management. Results: The research that was done showed a significant improvement when using CA over pharmacologic management for AF in stroke/TIA occurrence (p = 0.035; RR = 0.61 [95% CI, 0.386 to 0.965]; I = 0.0%), left ventricular ejection fraction (p =0.000; WMD=5.39 [95% CI, 2.45 to 8.32]; I2 84.4%) and (MD = 7.72, 95% CI [4.78, 10.67]; P < 0.00001), arrythmia recurrence (relative risk [RR], 0.40; 95% confidence interval [CI], 0.31−0.52; P=0.00001) and v (RR 1.82, 95% CI [1.33, 2.49]; P = 0.0002), the subsequent need for cardioversion (RR 0.59, 95% CI [0.46, 0.76]; P < 0.0001), complications in medical treatment (RR 1.95, 95% CI [0.52, 7.25]; P = 0.32), hospitalizations (RR 0.54, 95%CI [0.39, 0.74]; P = 0.0002), quality of life (MD 11.13, 95% CI [2.52–19.75]; P = 0.01) and adverse events (RR 0.54, 95%CI [0.39, 0.74]; P = 0.0002). Conclusion: The results of this research show that CA is a superior initial treatment modality for AF compared to pharmacologic management. CA seems to show improvement in multiple aspects of patient quality of life following an AF diagnosis. As we know, AF is a serious heart condition that millions of individuals are forced to deal with. From our perspective, CA used as first line treatment can reduce the burden more drastically as opposed to treating the patient with rate or rhythm control medication which has been the mainstay of treatment for years.