Evidence map›Paper›PMID 33909022›Full record

SynthesisJAMA cardiology2021

Assessment of Catheter Ablation or Antiarrhythmic Drugs for First-line Therapy of Atrial Fibrillation: A Meta-analysis of Randomized Clinical Trials.

Mohit K Turagam, Daniel Musikantow, William Whang, Jacob S Koruth, Marc A Miller, Marie-Noelle Langan, Aamir Sofi, Subbarao Choudry, Srinivas R Dukkipati, Vivek Y Reddy

2 registry-linked trialsOpen access · greenAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in JAMA cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 97 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
97citing papers in PubMed, 9 pooled it
18.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06307860 unknown statusnot on this mapstarted 2022, after this paper: background citation

Comparison of Pulse Field Ablation and Radiofrequency Ablation in Left Atrial Reverse Remodeling in Patients With Paroxysmal Atrial Fibrillation

TypeobservationalSponsorYun WanRan2022 to 2025Enrolled120ConditionsAtrial FibrillationArmspulsed field ablation, radiofrequency ablation
NCT06783868 not yet recruitingnot on this mapstarted 2025, after this paper: background citation

Randomized Control Study to Assess the Neurological Outcomes After Atrial Fibrillation Ablation for Rhythm Control vs Routine Medication Therapy in Patients With Recent Stroke: SAVE STROKE Phase II Study

TypeobservationalSponsorKansas City Heart Rhythm Research FoundationRan2025 to 2027Enrolled100ConditionsAtrial Fibrillation, StrokeArmsCatheter Ablation, Market-approved AVNB, OAC and AAD
3 · Its place in the literature

Who cites it

97 citing papers in PubMed, 9 syntheses or guidelines pooled it, 171 citations in OpenAlex.

  1. Pooled it
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  10. Cryoballoon ablation vs. antiarrhythmic drug therapy as initial treatment for persistent atrial fibrillation: the multicentre randomized CEPAF trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
    Trial
  11. Early recurrence of atrial tachyarrhythmia after catheter ablation and its associations with clinical outcomes, atrial fibrillation burden, and blanking period duration: a post hoc analysis of the CABANA trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
    Trial
  12. Trial
  13. Association between comorbidity burden and outcomes of catheter ablation vs. medical therapy for atrial fibrillation: insights from the CABANA trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025
    Trial
  14. Trial
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  17. Vein of Marshall ethanol infusion in persistent atrial fibrillation: Insight from VOMALC-PeAF registry.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
    Article
  18. Management of recurrent atrial fibrillation after catheter ablation: 5-year outcomes of repeat catheter ablation vs. antiarrhythmic therapy.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
    Article
  19. The impact of catheter ablation in congenital heart disease and atrial fibrillation: An updated meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
    Article
  20. Article

37 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 1 institution in 1 country.

Mohit K TuragamHelmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York.
Daniel MusikantowHelmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York.
William WhangHelmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York.
Jacob S KoruthHelmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York.
Marc A MillerHelmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York.
Marie-Noelle LanganHelmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York.
Aamir SofiHelmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York.
Subbarao ChoudryHelmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York.
Srinivas R DukkipatiHelmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York.
Vivek Y ReddyHelmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York.
Mount Sinai Hospital · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Early rhythm control of atrial fibrillation (AF) with either antiarrhythmic drugs (AADs) or catheter ablation has been reported to improve cardiovascular outcomes compared with usual care; however, the optimal therapeutic modality to achieve early rhythm control is unclear. Objective: To assess the safety and efficacy of AF ablation as first-line therapy when compared with AADs in patients with paroxysmal AF. Data Sources: PubMed/MEDLINE, Scopus, Google Scholar, and various major scientific conference sessions from January 1, 2000, through November 23, 2020. Study Selection: Randomized clinical trials (RCTs) published in English that had at least 12 months of follow-up and compared clinical outcomes of ablation vs AADs as first-line therapy in adults with AF. The quality of individual studies was assessed using the Cochrane risk of bias tool. Six RCTs met inclusion criteria, including 1212 patients. Data Extraction and Synthesis: Two investigators independently extracted data. Reporting was performed in compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Analysis was performed using a random-effects model with the Mantel-Haenszel method, and results are presented as 95% CIs. Main Outcomes and Measures: Main outcomes were safety and efficacy of AF ablation as first-line therapy when compared with AADs. Trials were evaluated as having low risk of selection and attrition biases, high risk of performance bias, and with unclear risk for detection biases due to unblinding and open-label designs. Results: A total of 6 RCTs involving 1212 patients with AF were included (609 were randomized to AF ablation and 603 to drug therapy; mean [SD] age, 56 [11] years). Compared with AADs, catheter ablation use was associated with reductions in recurrent atrial arrhythmia (32.3% vs 53%; risk ratio [RR], 0.62; 95% CI, 0.51-0.74; P < .001; I2 = 40%), with a number needed to treat with ablation to prevent 1 arrhythmia of 5. Use of ablation was also associated with reduced symptomatic atrial arrhythmia (11.8% vs 26.4%; RR, 0.44; 95% CI, 0.27-0.72; P = .001; I2 = 54%) and hospitalization (5.6% vs 18.7%; RR, 0.32; 95% CI, 0.19-0.53; P < .001) with no significant difference in serious adverse events between the groups (4.2% vs 2.8%; RR, 1.52; 95% CI, 0.81-2.85; P = .19). Conclusions and Relevance: In this meta-analysis of randomized clinical trials including first-line therapy of patients with paroxysmal AF, catheter ablation compared with antiarrhythmic drugs was associated with reductions in recurrence of atrial arrhythmias and hospitalizations, with no difference in major adverse events.

Indexed as

Catheter AblationAnti-Arrhythmia AgentsAtrial FibrillationHospitalizationHumansRandomized Controlled Trials as TopicAnti-Arrhythmia Agents

Identifiers

PMID33909022
PMCPMC8082432
OpenAlexW3158186502

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.