Cochrane Heart Group - Committee for Practice Guidelines

Atrial fibrillation (AF) is the most frequent arrhythmia seen in clinical practice. Antiarrhythmic medications have been the most commonly employed treatment for maintaining sinus rhythm; however, antiarrhythmic medications have a modest long-term efficacy and the potential for serious side effects. In the last decade non-pharmacological interventions (ablation techniques) have been developed as alternatives to antiarrhythmic medications in maintaining sinus rhythm in patients with AF and consequently avoiding the harmful cardiovascular events AF-related. The 2012 ESC guidelines on AF, although recognized the benefits of ablation techniques to reduce the symptoms associated with AF, at that time most the trials included an important proportion of patients with paroxysmal AF, that were already resistant to antiarrhytmic medications with no or minimal structural heart disease. Therefore, data on a direct comparison of antiarrhytmic medications vs ablation as first line therapy in patients with persistent or long-standing AF is limited. In addition, even for patients with paroxysmal AF data on efficacy and safety on long-term follow-up also limited. We will conduct a de-novo systematic review and meta-analysis to evaluate the efficacy and safety (in particular long-term) of ablation techniques in comparison to antiarrhytmic medications for the management of patient AF.