RESUMEN
Atrial fibrillation (AF) management has witnessed a paradigm shift, with an increasing emphasis on rhythm control strategies. This systematic review aims to comprehensively assess and compare the efficacy and safety of catheter ablation versus medical therapy in the treatment of AF. A systematic search was conducted across major electronic databases, including PubMed, Embase, and the Cochrane Library, from inception to the present. Randomized controlled trials (RCTs) and observational studies comparing catheter ablation with medical therapy for AF were included. The primary outcomes included rhythm control success, recurrence rates, and adverse events. Secondary outcomes encompassed quality of life, hospitalization rates, and mortality. A total of six studies met the inclusion criteria, comprising 2,859 participants. Catheter ablation significantly improved rhythm control success compared to medical therapy. Subgroup analyses demonstrated variations in outcomes based on patient characteristics, procedural techniques, and follow-up durations. Recurrence rates favored ablation; however, ablation was associated with a higher incidence of minor complications and major adverse events. Catheter ablation demonstrates superior efficacy in achieving and maintaining rhythm control compared to medical therapy in the management of AF. Despite the increased risk of procedural complications, the overall safety profile remains acceptable. This systematic review provides valuable insights for clinicians and informs shared decision-making between patients and healthcare providers when choosing between catheter ablation and medical therapy for AF treatment.
RESUMEN
INTRODUCTION: A major cause of death, coronary artery disease (CAD) often necessitates invasive procedures like coronary bypass grafting (CABG) and percutaneous coronary intervention (PCI). Cardiovascular outcomes vary between indigenous and non-indigenous Australian people; however, comprehensive knowledge of these differences is absent. METHODOLOGY: To compare PCI and CABG results between indigenous and non-indigenous Australians, a systematic review and meta-analysis were carried out. Included were 10 retrospective observational studies that examined mortality, cardiovascular events, comorbidities, and operative success rates. Databases spanning 2014 to 2024 were searched, and research that directly compared Australia's indigenous and non-indigenous populations was among the inclusion criteria. RESULTS: Within 30 days of surgery, indigenous Australians receiving PCI had greater rates of comorbidities and were at higher risk of long-term mortality and MACE. Similarly, there was a greater long-term death rate among indigenous patients following CABG. Cultural safety, socioeconomic factors, and regional factors affecting treatment delays and access to care all affected disparities. For 30-day mortality, the pooled analysis shows an odds ratio of 1.04 (95% CI 0.78, 1.40), indicating no meaningful difference. The total odds ratio for unfavorable occurrences is 1.07 (95% CI 0.86, 1.33), meaning there is no statistically significant difference between Indigenous groups and those that are not. CONCLUSION: Indigenous Australians continue to have worse cardiovascular outcomes after PCI and CABG procedures, even with similar procedural success rates. To ensure equitable cardiovascular outcomes for indigenous groups, targeted therapies targeting underlying risk factors, increased access to culturally appropriate care, and decreased obstacles to healthcare access are critical.