CATHETER ABLATION VERSUS PHARMACOLOGICAL TREATMENT IN ATRIAL FIBRILLATION: AN INTEGRATIVE REVIEW

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with an increased risk of stroke, heart failure (HF), and mortality. This study aimed to analyze the efficacy and safety of catheter ablation compared with pharmacological treatment in adults with AF. This is an integrative review conducted in the PubMed and Virtual Health Library databases, using the descriptors Atrial Fibrillation, Catheter Ablation, and Anti-Arrhythmia Agents. Of the 54 studies screened, 25 were included: eight randomized clinical trials, ten secondary analyses of the CABANA trial, and seven meta-analyses or systematic reviews. Ablation was superior to antiarrhythmic drugs in maintaining sinus rhythm, including as first-line therapy, and was associated with fewer hospitalizations and better quality of life. A reduction in mortality and stroke was observed in meta-analyses, especially in patients with HF, but not in the primary endpoint of CABANA. The benefit was greater in younger patients, in those with HF with preserved ejection fraction, or with a higher comorbidity burden. Catheter ablation is the most effective strategy for rhythm control in AF, and its indication should be individualized.