A total of six RCTs (n=744) were included in the review. One of these was rated as being of good quality and five were rated as fair.
First-line treatment of patients with recent onset paroxysmal atrial fibrillation (one RCT, n=67): Patients who received catheter ablation had significantly lower recurrence of atrial fibrillation than those who received antiarrhythmic drugs (13% versus 63%, p<0.001).
Treatment of symptomatic patients with paroxysmal or persistent atrial fibrillation who have failed antiarrhythmic drugs (four RCTs, n=593): All four RCTs reported large statistically significant reductions in atrial fibrillation recurrence at one year follow-up that favoured treatment using catheter ablation (range 47% to 70%). One RCT reported an improvement that favoured catheter ablation on six of eight SF-36 quality of life subscales. One RCT reported significant within-group improvement in symptoms from baseline in the catheter ablation group (p=0.02).
Treatment of patients with atrial fibrillation and congestive heart failure who have failed standard medication regimens (one RCT, n=81): Patients who received atrioventricular node ablation had significantly lower recurrence of atrial fibrillation than those who received pulmonary vein isolation (26% versus 96%, p<0.001).
None of the RCTs provided adequate information on cardiovascular events or complications.