Comparing energy sources for surgical ablation of atrial fibrillation: a Bayesian network meta-analysis of randomized, controlled trials.
Simplified maze procedures involving radiofrequency, cryoenergy and microwave energy sources have been increasingly utilized for surgical treatment of atrial fibrillation as an alternative to the traditional cut-and-sew approach. In the absence of direct comparisons, a Bayesian network meta-analysis is another alternative to assess the relative effect of different treatments, using indirect evidence. A Bayesian meta-analysis of indirect evidence was performed using 16 published randomized trials identified from 6 databases. Rank probability analysis was used to rank each intervention in terms of their probability of having the best outcome. Sinus rhythm prevalence beyond the 12-month follow-up was similar between the cut-and-sew, microwave and radiofrequency approaches, which were all ranked better than cryoablation (respectively, 39, 36, and 25 vs 1%). The cut-and-sew maze was ranked worst in terms of mortality outcomes compared with microwave, radiofrequency and cryoenergy (2 vs 19, 34, and 24%, respectively). The cut-and-sew maze procedure was associated with significantly lower stroke rates compared with microwave ablation [odds ratio <0.01; 95% confidence interval 0.00, 0.82], and ranked the best in terms of pacemaker requirements compared with microwave, radiofrequency and cryoenergy (81 vs 14, and 1, <0.01% respectively). Bayesian rank probability analysis shows that the cut-and-sew approach is associated with the best outcomes in terms of sinus rhythm prevalence and stroke outcomes, and remains the gold standard approach for AF treatment. Given the limitations of indirect comparison analysis, these results should be viewed with caution and not over-interpreted.
The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia.
Kevin
K
Phan
The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
Ashleigh
A
Xie
Department of Cardiothoracic Surgery and Cardiology, Academic Hospital Maastricht and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
Narendra
N
Kumar
Gosford District Hospital, Gosford, Australia.
Sophia
S
Wong
Department of Cardiology and Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Caroline
C
Medi
Department of Cardiothoracic Surgery and Cardiology, Academic Hospital Maastricht and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands University Hospital Brussels, Brussels, Belgium.
Mark
M
La Meir
The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia Department of Cardiology and Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia tristanyan@annalscts.com.
Tristan D
TD
Yan
D001281:Atrial Fibrillation / Q000601:surgery*; D001499:Bayes Theorem; D001674:Bioelectric Energy Sources; D017115:Catheter Ablation / Q000379:methods*; D003452:Cryosurgery / Q000379:methods; D006801:Humans; D008872:Microwaves / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
Ablation; Atrial fibrillation; Meta-analysis; Randomized controlled trial