Seven RCTs (n=603) were included.
In all studies, treatment groups were comparable at baseline with respect to age, gender and, where reported, the proportion of patients with pre-existing structural heart disease.
There were no significant differences between groups treated using 8-mm and cRFA with respect to:
BIB achievement with the primary intent catheter (84% versus 85%; RR 0.96, 95% CI: 0.92, 1.01; I-squared 3%),
BIB achievement in intention-to-treat analysis after crossover (99.4% versus 99.7%),
total radiofrequency application time (13.2 versus 12.5 minutes; WMD 0.88, 95% CI: -0.36, 2.12; heterogeneity p=0.76),
X-ray exposure time (21 versus 18.9 minutes; WMD 1.07, 95% CI: -0.81, 2.95; heterogeneity p=0.45), and
the duration of the ablation procedure (82.2 versus 81 minutes; WMD 0.68, 95% CI: -3.37, 4.73; heterogeneity p=0.07).
Statistically significant heterogeneity was only found for the analysis of duration of ablation procedure.
Long-term recurrence rates of AFL were similar (2.3% versus 1.6%; based on 4 RCTs).