title: A systematic review of surgical ablation versus catheter ablation for atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is an increasingly prevalent condition in the ageing population, with significantly associated morbidity and mortality. Surgical and catheter ablative strategies both aim to reduce mortality and morbidity through freedom from AF. This review consolidates all currently available comparative data to evaluate these two interventions.
  
  
  METHODS
  A systematic search was conducted across MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews from January 2000 until August 2013. All studies were critically appraised and only those directly comparing surgical and catheter ablation were included.
  
  
  RESULTS
  Seven studies were deemed suitable for analysis according to the inclusion criteria. Freedom from AF was significantly higher in the surgical ablation group versus the catheter ablation group at 6-month, 12-month and study endpoint follow-up periods. Subgroup analysis demonstrated similar trends, with higher freedom from AF in the surgical ablation group for paroxysmal AF patients. The incidence of pacemaker implantation was higher, while no difference in stroke or cardiac tamponade was demonstrated for the surgical versus catheter ablation groups.
  
  
  CONCLUSIONS
  Current evidence suggests that epicardial ablative strategies are associated with higher freedom from AF, higher pacemaker implantation rates and comparable neurological complications and cardiac tamponade incidence to catheter ablative treatment. Other complications and risks were poorly reported, which warrants further randomized controlled trials (RCTs) of adequate power and follow-up duration.
authors: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ;
authors: Katherine
authors: K
authors: Kearney
authors: St Vincent's Hospital, Sydney, Australia, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors: Rowan
authors: R
authors: Stephenson
authors: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ;
authors: Kevin
authors: K
authors: Phan
authors: University of Western Sydney, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors: Wei Yen
authors: WY
authors: Chan
authors: University of Western Sydney, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors: Min Yin
authors: MY
authors: Huang
authors: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; ; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors: Tristan D
authors: TD
authors: Yan
keywords: Atrial fibrillation (AF); catheter ablation; endocardial ablation; epicardial ablation; surgical ablation