title: Long-term stroke rates after catheter ablation or antiarrhythmic drug therapy for atrial fibrillation: a meta-analysis of randomized trials.
abstract: BACKGROUND
  Atrial fibrillation (AF) is an independent risk factor for ischemic stroke and is associated with increased risk of death. Randomized studies suggest improved quality of life for patients with AF after successful catheter ablation compared to antiarrhythmic drug therapy. The value of ablation in long-term risk of ischemic stroke, however, has not been assessed. We conducted a meta-analysis to determine whether AF ablation reduces the long-term risk of stroke compared to antiarrhythmic drug therapy in randomized controlled trials.
  
  
  RESULTS
  PubMed and the Cochrane Central Register were searched for randomized trials from January 1990 to December 2014 comparing AF catheter ablation to drug therapy. The results are reported as risk differences (RDs) and 95% CI. Thirteen trials were analyzed with 1097 patients treated by catheter ablation and 855 patients received antiarrhythmic drug therapy. Overall, seven patients (0.64%) in the catheter ablation group had ischemic stroke or transient ischemic attacks vs. two patients (0.23%) in the drug therapy group. No difference was shown in the rate of stroke or transient ischemic attack between ablation and drug therapy (RD: 0.003, 95% CI: -0.006 to 0.012, P = 0.470), and no evidence of heterogeneity was observed (I (2) = 0, P = 0.981). No potential publication bias was found. There was also no difference in mortality between the two groups (RD: -0.004, 95% CI: -0.014 to 0.006, P = 0.472).
  
  
  CONCLUSIONS
  This meta-analysis of randomized controlled trials showed similar rates of ischemic stroke or transient ischemic attack and death in AF patients undergoing catheter ablation compared to drug therapy. A larger prospective randomized trial to confirm this finding is warranted.
authors.affiliation: Department of Cardiology, College of Medical, the First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Ya-Ru
authors.initials: YR
authors.lastname: Zheng
authors.affiliation: Department of Cardiology, College of Medical, the First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Zhi-Yun
authors.initials: ZY
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
authors.forename: Li-Fang
authors.initials: LF
authors.lastname: Ye
authors.affiliation: Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
authors.forename: Li-Hong
authors.initials: LH
authors.lastname: Wang
keywords: Antiarrhythmic drug; Atrial fibrillation; Catheter ablation; Death; Stroke