Five RCTs were included in the review (n=578). The methodological quality of the studies was low.
Catheter ablation was more effective at preventing recurrence of atrial fibrillation than either pharmacological treatment or no treatment. After one year atrial fibrillation was present in 25 per cent of patients who received catheter ablation compared with 67 per cent of patients who received pharmacological treatment or no treatment. Meta-analysis was not performed, because of significant heterogeneity (I2 = 73%).
Two patients who received catheter ablation died (one from a stroke and the other pneumonia). There was one other stroke case, one case of moderate pulmonary vein stenosis, one case of transitory paresis of the phrenic nerve, one transient ischemic attack, one case of groin haematoma and two patients required pericardial drainage.
One control-group patient died. One study reported 23 per cent withdrawal from treatment due to adverse effects from amiodarone, flecainide and/or sotalol (alone or in combination). One study reported that 47 per cent of patients taking amiodarone suffered from adverse effects.