Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta‐analysis of randomized controlled trials

BackgroundRecent randomized controlled trials (RCTs) suggest that ablation is superior to antiarrhythmic drugs (AADs) as an initial therapy for paroxysmal atrial fibrillation (pAF) to prevent arrhythmia recurrences. We performed an updated meta‐analysis of RCTs, to include recent data from cryoballoon‐based ablation and to compare arrhythmia‐free survival and adverse events between ablation and AADs.MethodsWe searched MEDLINE and EMBASE from inception to December 2020. We included RCT comparing patients with pAF undergoing ablation or receiving AADs as an initial therapy. We combined data using the random‐effects model to calculate hazards ratio (HR) for arrhythmia‐free survival and odds ratio (OR) for adverse events.ResultsFive studies from 2005 to 2020 involving 985 patients were included (495 patients and 490 patients underwent ablation and medication as initial therapy, respectively). Patients who underwent ablation had higher freedom from atrial tachyarrhythmias (ATs) during the 12‐24 months follow‐up period (pooled HR = 0.48, 95% CI: 0.40‐0.59, P < .001). In a subgroup analysis of ablation method used, both cryoablation group (pooled HR = 0.49, 95% CI: 0.38‐0.64, P < .001) and radiofrequency ablation group (pooled HR = 0.47, 95%CI: 0.35‐0.64, P < .001) showed reduction in AT recurrence compared with AAD group. There were no differences in adverse events including cerebrovascular accident, pericardial effusion or tamponade, pulmonary vein stenosis, acute coronary syndrome, deep vein thrombosis and pulmonary embolism, and bradycardia requiring a pacemaker.ConclusionCatheter ablation (both cryoablation and radiofrequency ablation) is superior to AAD as an initial therapy for pAF in efficacy for reducing AT recurrences without a compromise in adverse events.We performed meta‐analysis of the most recent randomized control trials evaluating atrial fibrillation ablation as the first line therapyPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171132/1/joa312641_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171132/2/joa312641.pd

Rhythm control in patients with heart failure with preserved ejection fraction: A meta-analysis

Background The presence of atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) dramatically increases higher morbidity and mortality. Recent studies have suggested that early rhythm control may alleviate the burden of poor outcomes. Cur-rently, there remain limited data on whether rhythm or rate control has better efficacy. This study sought to compare both strategies in HFpEF patients with AF. Methods Databases were searched throughout 2020. Studies that reported cardiovascular outcomes amongst HFpEF patients with AF who received either rhythm or rate control were included. Estimates of the effects from the individual studies were extracted and combined using random-effects, a generic inverse variance method of DerSimonian and Laird. Results Five observational studies were included in the analysis, consisting of 16,953 patients, 13.8% of whom were receiving rhythm control. In comparison with rate control, rhythm control was associated with decreased overall mortality rates (pooled RR 0.85, 95% CI 0.75–0.95, with I2 = 0%, p value = 0.009). Conclusions In HFpEF patients with AF, rhythm control was associated with lower mortality, compared to rate control. Further studies are warranted to validate our observation. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Temporal Trends in Substance Use and Cardiovascular Disease–Related Mortality in the United States

Background There are limited data on substance use (SU) and cardiovascular disease (CVD)–related mortality trends in the United States. We aimed to evaluate SU+CVD–related deaths in the United States using the Centers for Disease Control and Prevention Wide‐Ranging, Online Data for Epidemiologic Research database. Methods and Results The Multiple Cause‐of‐Death Public Use record death certificates were used to identify deaths related to both SU and CVD. Crude, age‐adjusted mortality rates, annual percent change, and average annual percent changes with a 95% CI were analyzed. Between 1999 and 2019, there were 636 572 SU+CVD‐related deaths (75.6% men, 70.6% non‐Hispanic White individuals, 65% related to alcohol). Age‐adjusted mortality rates per 100 000 population were pronounced in men (22.5 [95% CI, 22.6–22.6]), American Indian or Alaska Native individuals (37.7 [95% CI, 37.0–38.4]), nonmetropolitan/rural areas (15.2 [95% CI, 15.1–15.3]), and alcohol‐related death (9.09 [95% CI, 9.07 to 9.12]). The overall SU+CVD‐related age‐adjusted mortality rates increased from 9.9 (95% CI, 9.8–10.1) in 1999 to 21.4 (95% CI, 21.2–21.6) in 2019 with an average annual percent change of 4.0 (95% CI, 3.7–4.3). Increases in SU+CVD‐related average annual percent change were noted across all subgroups and were pronounced among women (4.8% [95% CI, 4.5–5.1]), American Indian or Alaska Native individuals, younger individuals, nonmetropolitan areas, and cannabis and psychostimulant users. Conclusions There was a prominent increase in SU+CVD‐related mortality in the United States between 1999 and 2019. Women, non‐Hispanic American Indian or Alaska Native individuals, younger individuals, nonmetropolitan area residents, and users of cannabis and psychostimulants had pronounced increases in SU+CVD mortality