Insights from clinical trials: New evidence supports surgical interventions over drug therapies for atrial fibrillation

Abstract

Atrial fibrillation (AF) is one of the world’s most prevalent cardiac arrhythmias. It poses a heavy burden on patients, physicians and the global healthcare system as it is one of the top leading causes of cardiovascular death. Researchers have spent numerous years conducting clinical trials to investigate the effectiveness, cost and practicality of treatment for patients suffering from AF. The primary treatment strategy for AF (acute, chronic, persistent, paroxysmal, non-valvular, nonrheumatic, and rapid) involves the use of antiarrhythmic drugs (AAD) and anticoagulant drugs (ACD) to manage heart rate and rhythm, as well as to prevent strokes. This review aims to discuss clinical trials that compared AADs (class Ia: quinidine; class Ic: flecainide, propafenone; class III: sotalol, amiodarone) and ACDs (vitamin K antagonist: warfarin; factor Xa inhibitor: apixaban, rivaroxaban; thrombin inhibitor: dabigatran) with cardiovascular surgical interventions (i.e., catheter ablation, cryoballoon ablation, ablation and DDDR pacemaker, electrical cardioversion, and left atrial appendage occlusion) to treat various types of AF in patients with a diverse history of cardiovascular diseases and medical history. This study provides a review of clinical trials on this topic and enables healthcare professionals to determine the best-suited treatment for their patients.