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Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: protocol of a network meta-analysis of randomised controlled trials
  1. Emmanouil Charitakis1,
  2. Lars O Karlsson1,
  3. Kostantinos Rizas2,
  4. Henrik Almroth1,
  5. Anders Hassel Jönsson1,
  6. Jonas Schweiler3,
  7. Skevos Sideris4,
  8. Dimitrios Tsartsalis5,
  9. Elena Dragioti6,
  10. Anna Chaimani7
  1. 1 Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University Hospital, Linköping, Sweden
  2. 2 Department of Cardiology, LMU München, Munchen, Germany
  3. 3 Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
  4. 4 Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Attica, Greece
  5. 5 Department of Clinical Physiology, Linköping University Hospital, Linköping, Sweden
  6. 6 Pain and Rehabilitation Center and Department of Health and Caring Sciences, Linköping University, Linköping, Sweden
  7. 7 Research Center of Epidemiology and Statistics (CRESS-U1153), Univeristé de Paris, Paris, Île-de-France, France
  1. Correspondence to Dr Emmanouil Charitakis; emmanouil.charitakis{at}


Introduction Atrial fibrillation (AF) is the most common sustained arrhythmia. Catheter ablation (CA) of AF is an increasingly offered therapeutic approach, primary to relieve AF-related symptoms. Despite the development of new ablation approaches, there is no consensus regarding the most efficient ablation strategy. The objective of this network meta-analysis (NMA) is to compare the efficacy and safety of all different CA approaches for the treatment of patients with paroxysmal (PAF) and non-PAF (non-PAF).

Methods and analysis We will perform a systematic search to identify randomised controlled trials of different CA approaches for the treatment of PAF and non-PAF, through the final search date of 1 March 2020. Information sources will include major bibliographic databases (MEDLINE, Web of Science and CENTRAL) and clinical trial registries. Our primary outcomes will be the efficacy (recurrence-free survival) and safety of different CA approaches for the treatment of AF. Secondary outcomes will be all-cause mortality and procedural time. An NMA will be performed to determine the relative effects of different catheter ablation approaches (such as pulmonary vein isolation alone or in combination with ablation lines, ablation of complex fractionated atrial electrograms, etc). In PAF, a separate analysis will be performed including different energy sources (such as radiofrequency, cryogenic and laser energy). Risk of bias assessment and sensitivity analyses will be conducted to assess the robustness of the findings to potential bias.

Ethics and dissemination No ethical approval will be needed because data are collected from previous studies. The results will be presented through peer-review journals and conference presentation.

PROSPERO registration number CRD42020169494.

  • pacing & electrophysiology
  • statistics & research methods
  • cardiac epidemiology
  • adult cardiology

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  • Twitter @mcharitakis, @dtsartsal

  • Contributors EC and ED were responsible for the conception and design of the study and for writing the initial protocol draft. ED and AC developed the statistical analysis plan. ED, AC, LOK, KR, HA, AHJ, JS, DT and SS provided critical revisions of all aspects of the review. The final protocol has been approved by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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