{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T11:40:33Z","timestamp":1774352433639,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:00:00Z","timestamp":1632873600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Recent 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\u2010analysis of RCTs, to include recent data from cryoballoon\u2010based ablation and to compare arrhythmia\u2010free survival and adverse events between ablation and AADs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We 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\u2010effects model to calculate hazards ratio (HR) for arrhythmia\u2010free survival and odds ratio (OR) for adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five 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\u201024\u00a0months follow\u2010up period (pooled HR\u00a0=\u00a00.48, 95% CI: 0.40\u20100.59, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). In a subgroup analysis of ablation method used, both cryoablation group (pooled HR\u00a0=\u00a00.49, 95% CI: 0.38\u20100.64, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and radiofrequency ablation group (pooled HR\u00a0=\u00a00.47, 95%CI: 0.35\u20100.64, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Catheter 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/joa3.12641","type":"journal-article","created":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T20:26:16Z","timestamp":1632947176000},"page":"1448-1458","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta\u2010analysis of randomized controlled trials"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0959-5576","authenticated-orcid":false,"given":"Jakrin","family":"Kewcharoen","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine Loma Linda University Health Loma Linda CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Narut","family":"Prasitlumkum","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of California Riverside School of Medicine Riverside CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronpichai","family":"Chokesuwattanaskul","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Thai Red Cross Society Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruiyang","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine John A. Burns School of Medicine Honolulu Hawaii USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krit","family":"Jongnarangsin","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Department of Internal Medicine University of Michigan Medical School Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5349-0136","authenticated-orcid":false,"given":"Thomas J.","family":"Bunch","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravi","family":"Ranjan","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7087-1707","authenticated-orcid":false,"given":"Leenhapong","family":"Navaravong","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah 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