{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:20:25Z","timestamp":1791908425480,"version":"4.3.4"},"reference-count":22,"publisher":"IMR Press","issue":"3","license":[{"start":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T00:00:00Z","timestamp":1632441600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>When multiple treatments are available, network meta-analysis can evaluate data to rank the relative effectiveness. We applied this approach to first-line treatments for paroxysmal atrial fibrillation (medical therapy, radiofrequency ablation or cryoballoon ablation). Individual trials were analysed based on the restricted mean survival time (RMST). Randomised controlled trials (RCT) assessing first-line treatments for paroxysmal atrial fibrillation were referenced from PubMed and the websites of regulatory agencies. The primary end-point was atrial fibrillation recurrence-free survival at 12 months. The treatments assessed for their relative effectiveness were medical therapy, radiofrequency ablation and cryoballoon ablation. Individual trials were examined based on RMST. A Bayesian network meta-analysis was conducted to comparatively evaluate these treatments. Five trials were included in the analysis: two compared radiofrequency with medical treatment and three cryoballoon ablation with medical treatment. The indirect comparison of radiofrequency ablation vs cryoballoon ablation was assessed in the absence of RCTs. Differences in RMST (with 95% credible intervals) were estimated for all binary comparisons (direct or indirect). Radiofrequency and cryoballoon ablation showed significantly increased effectiveness compared with medical treatment. In the indirect comparison, radiofrequency showed a non-significant advantage over cryoballoon ablation. The ranking of effectiveness was as follows: (1) radiofrequency; (2) cryoballoon ablation; (3) medical treatment. In conclusion, we found that radiofrequency was the most effective treatment for paroxysmal atrial fibrillation according to a Bayesian probabilistic model.<\/jats:p>","DOI":"10.31083\/j.rcm2203067","type":"journal-article","created":{"date-parts":[[2021,9,26]],"date-time":"2021-09-26T02:35:45Z","timestamp":1632623745000},"source":"Crossref","is-referenced-by-count":11,"title":["Medical therapy, radiofrequency ablation or cryoballoon ablation as first-line treatment for paroxysmal atrial fibrillation: interpreting efficacy through restricted mean survival time and network meta-analysis"],"prefix":"10.31083","volume":"22","author":[{"given":"Andrea","family":"Messori","sequence":"first","affiliation":[{"name":"Heath Technology Assessment TA Unit and Ente Supporto Tecnico Amministrativo, Regional Health Service, 50100 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Bartoli","sequence":"first","affiliation":[{"name":"Heath Technology Assessment TA Unit and Ente Supporto Tecnico Amministrativo, Regional Health Service, 50100 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Ferracane","sequence":"first","affiliation":[{"name":"Heath Technology Assessment TA Unit and Ente Supporto Tecnico Amministrativo, Regional Health Service, 50100 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Trippoli","sequence":"first","affiliation":[{"name":"Heath Technology Assessment TA Unit and Ente Supporto Tecnico Amministrativo, Regional Health Service, 50100 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2021,9,24]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Fortuni F, Casula M, Sanzo A, Angelini F, Cornara S, Somaschini A, et al. Meta-Analysis Comparing Cryoballoon Versus Radiofrequency as first Ablation Procedure for Atrial Fibrillation. The American Journal of Cardiology. 2020; 125: 1170\u20131179.","DOI":"10.1016\/j.amjcard.2020.01.016"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Mao Y, Wang H, Chen J, Huang P. Meta-analysis of medical management versus catheter ablation for atrial fibrillation. Reviews in Cardiovascular Medicine. 2020; 21: 419\u2013432.","DOI":"10.31083\/j.rcm.2020.03.60"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Ravi V, Poudyal A, Pulipati P, Larsen T, Krishnan K, Trohman RG, et al. A systematic review and meta\u2010analysis comparing second\u2010generation cryoballoon and contact force radiofrequency ablation for initial ablation of paroxysmal and persistent atrial fibrillation. Journal of Cardiovascular Electrophysiology. 2020; 31: 2559\u20132571.","DOI":"10.1111\/jce.14676"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Andrade JG, Wells GA, Deyell MW, Bennett M, Essebag V, Champagne J, et al. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. New England Journal of Medicine. 2021; 384: 305\u2013315.","DOI":"10.1056\/NEJMoa2029980"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Wazni OM, Dandamudi G, Sood N, Hoyt R, Tyler J, Durrani S, et al. Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. New England Journal of Medicine. 2021; 384: 316\u2013324.","DOI":"10.1056\/NEJMoa2029554"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Morillo CA, Verma A, Connolly SJ, Kuck KH, Nair GM, Champagne J, et al. Radiofrequency Ablation vs Antiarrhythmic Drugs as first-Line Treatment of Paroxysmal Atrial Fibrillation (RAAFT-2): a randomised trial. Journal of the American Medical Association. 2014; 311: 692.","DOI":"10.1001\/jama.2014.467"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, Saliba W, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. Journal of the American Medical Association. 2005; 293: 2634\u20132640.","DOI":"10.1001\/jama.293.21.2634"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Kuniss M, Pavlovic N, Velagic V, Hermida JS, Healey S, Arena G, et al. Cryoballoon ablation vs. antiarrhythmic drugs: first-line therapy for patients with paroxysmal atrial fibrillation. EP Europace. 2021; 23: 1033\u20131041.","DOI":"10.1093\/europace\/euab029"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Cosedis Nielsen J, Johannessen A, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. The New England Journal of Medicine. 2012; 367: 1587\u20131595.","DOI":"10.1056\/NEJMoa1113566"},{"key":"ref10","unstructured":"Messori A. The advantages of restricted mean survival time in analysing Kaplan-Meier survival curves: analysis of 55 articles published in the last 12 months (preprint). Zenodo repository. 2021. Available at: https:\/\/zenodo.org\/record\/5068693\/files\/Fifty-five%20papers%20published%20on%20the%20RMST.pdf?download=1 (Accessed: 30 August 2021)."},{"key":"ref11","unstructured":"PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Available at: http:\/\/www.prisma-statement.org (Accessed: 30 August 2021)."},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Messori A, Bartoli L, Chiumente C, Mengato D, Trippoli S. The restricted mean survival time as a tool for ranking comparative outcomes in a narrative review that evaluates a network of randomised trials: an example based on PCSK9 inhibitors. American Journal of Cardiovascular Drugs. 2021; 21: 349\u2013354.","DOI":"10.1007\/s40256-020-00444-8"},{"key":"ref13","unstructured":"Uno H, Tian L, Horiguchi M, Cronin A, Battioui C, Bell J. Package \u201csurvRM2\u201d. 2020. Available at: https:\/\/cran.r-project.org\/web\/packages\/survRM2\/survRM2.pdf (Accessed: 1 March 2021)."},{"key":"ref14","unstructured":"Dias S, Welton NJ, Sutton AJ, Ades AE. NICE DSU Technical Support Document 2: A Generalised Linear Modelling Framework for Pairwise and Network Meta-Analysis of Randomised Controlled Trials [Internet]. London: National Institute for Health and Care Excellence (NICE). 2014. Available at: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK310366\/ (Accessed 30 August 2021)."},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Fadda V, Bartoli L, Ferracane E, Trippoli S, Messori A. Simplified figure to present direct and indirect comparisons: Revisiting the graph 10 years later. World Journal of Methodology. 2021; 11: 228\u2013230.","DOI":"10.5662\/wjm.v11.i4.228"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Fadda V, Maratea D, Trippoli S, Messori A. Network meta-analysis. Results can be summarised in a simple figure. British Medical Journal. 2011; 342: d1555.","DOI":"10.1136\/bmj.d1555"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"De Vecchis R, Ariano C, Rigopoulos A, Noutsias M. Graphical representation of network meta-analysis: an iconographic support to the complexity of multiple data comparisons. European Journal of Clinical Pharmacology. 2019; 75: 131\u2013132.","DOI":"10.1007\/s00228-018-2551-0"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Mills EJ, Thorlund K, Ioannidis JP. Demystifying trial networks and network meta-analysis. British Medical Journal. 2013; 346: f2914.","DOI":"10.1136\/bmj.f2914"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Balshem H, Helfand M, Sch\u00fcnemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology. 2011; 64: 401\u2013406.","DOI":"10.1016\/j.jclinepi.2010.07.015"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Messori A, Bartoli L, Ferracane E, Trippoli S. Medical therapy, radiofrequency ablation or cryoballoon ablation as first-line treatment for paroxysmal atrial fibrillation: interpreting efficacy through restricted mean survival time and network meta-analysis (preprint). Open Science Framework, https:\/\/osf.io\/at9sh\/ (Accessed: 30 August 2021).","DOI":"10.31083\/j.rcm2203067"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Petit C, Blanchard P, Pignon J, Lueza B. Individual patient data network meta-analysis using either restricted mean survival time difference or hazard ratios: is there a difference? A case study on locoregionally advanced nasopharyngeal carcinomas. Systematic Reviews. 2019; 8: 96.","DOI":"10.1186\/s13643-019-0984-x"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Kuck K, Brugada J, F\u00fcrnkranz A, Metzner A, Ouyang F, Chun KRJ, et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. New England Journal of Medicine. 2016; 374: 2235\u20132245.","DOI":"10.1056\/NEJMoa1602014"}],"container-title":["Reviews in Cardiovascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/22\/3\/10.31083\/j.rcm2203067","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T17:06:20Z","timestamp":1732727180000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/22\/3\/10.31083\/j.rcm2203067"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,24]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021]]}},"alternative-id":["1632453055052-1970040143"],"URL":"https:\/\/doi.org\/10.31083\/j.rcm2203067","relation":{},"ISSN":["1530-6550","2153-8174"],"issn-type":[{"value":"1530-6550","type":"print"},{"value":"2153-8174","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,24]]},"article-number":"557"}}