CATHETER ABLATION VERSUS SHAM FOR SYMPTOMATIC ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND BAYESIAN META-ANALYSIS OF RANDOMIZED TRIALS
In brief
Catheter ablation cuts atrial fibrillation recurrence by about half
In a review of four sham-controlled trials involving 468 patients, ablation improved quality-of-life scores by 13.5 points and reduced atrial fibrillation recurrence by about half. Results favored ablation across trials, but differences in patient symptoms, monitoring and blinding created substantial variation in the size of the quality-of-life benefit, whose evidence certainty was low.
- Journal
- Heart rhythm (Q1)
- Published
- 22 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Saikiran Kakarla, Hidehiro Iwakawa, Jason G Andrade, Jonathan P Ariyaratnam, Melanie A Gunawardene, Nassir Marrouche, et al.
- PMID
- 42913986
- DOI
- 10.1016/j.hrthm.2026.10.039
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (paper of the day, 26 October 2026): Sham-controlled evidence for AF ablation benefits
Abstract
BACKGROUND: Catheter ablation reduces atrial fibrillation (AF) recurrence and improves symptoms and quality of life (QoL), but sham-controlled trials have reported discordant results. OBJECTIVE: To synthesise sham-controlled trials of AF ablation and identify why QoL results differ. METHODS: We searched databases and registries for randomized trials of catheter ablation versus sham in symptomatic AF. The primary outcome was the between-group difference in Atrial Fibrillation Effect on Quality-of-Life (AFEQT) score, pooled using a Bayesian random-effects model. Certainty was rated with the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Four trials (468 patients) were eligible; three (448 patients) were pooled. Ablation improved AFEQT relative to sham by 13.5 points (95% credible interval [CrI] 1.6 to 26.9), with a posterior probability of benefit 0.98, of exceeding the 5-point minimal clinically important difference 0.94, and by 12.9 points (-0.4 to 27.1; probability 0.97 and 0.91) with PVI-SHAM-AF's primary estimator. Heterogeneity (τ 8.2 points, I2 85.3%) was largely attributed to PVI-SHAM-AF, which differed from the other trials in symptom severity, rhythm monitoring and assessment of blinding; without it, the difference was 18.9 points (6.7 to 31.4). Ablation reduced AF recurrence in every trial (pooled risk ratio 0.49, CrI 0.17-0.89). Certainty was moderate for AF burden and recurrence and low for QoL. CONCLUSION: Compared with sham embedded in active rhythm control, catheter ablation reduces AF recurrence and burden and has a high probability of clinically important QoL benefit, although its magnitude remains uncertain. Trials differ in population, monitoring, and estimator, not direction of effect.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.