Ablação cardíaca comparada à terapia farmacológica para tratamento de fibrilação atrial: uma revisão sistemática
Data
2025-01-20
Autores
Bocchini, Maria Fernanda Sinzato 
Orientadores
Pereira, Edimar Cristiano
Tipo
Trabalho de conclusão de curso
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A fibrilação atrial (FA) é a arritmia cardíaca mais comum e associa-se ao aumento da mortalidade e ao risco de insuficiência cardíaca, acidente vascular cerebral (AVC) e comprometimento cognitivo tardio. O avanço da idade, obesidade, apneia do sono, sedentarismo e diabetes mellitus são alguns fatores de risco proeminentes para a FA. Torna-se então de suma importância a análise de métodos de detecção e tratamentos adequados para a patologia a fim de minimizar complicações graves. Dentre os tipos de tratamento disponíveis, os medicamentos antiarrítmicos e a ablação cardíaca por cateter são os métodos mais amplamente utilizados na terapia. Uma revisão sistemática foi realizada para avaliar as diferenças na taxa de recorrência de fibrilação atrial em pacientes submetidos à ablação e pacientes submetidos ao tratamento farmacológico. Buscas na base de dados PubMed e SciELO foram executadas considerando estudos clínicos publicados no período de 2020 a 2024 que avaliavam os desfechos nos sintomas da FA em pacientes submetidos à ablação ou terapia farmacológica. Ao todo, sete estudos clínicos foram selecionados e analisados conforme os critérios de elegibilidade, sendo três estudos comparando a ablação de radiofrequência e quatro estudos comparando a crioablação com medicamentos antiarrítmicos das classes I e III. A taxa de recorrência de FA em todos os estudos foi menor utilizando a ablação em relação ao tratamento farmacológico, evidenciando uma melhor eficiência na redução dos sintomas de FA com o procedimento de ablação.
Atrial fibrillation (AF) represents the most prevalent cardiac arrhythmia and it is associated with an increased mortality rate, as well as heightened risks of heart failure, cerebrovascular accidents (CVA), and late cognitive impairment. Advancing age, obesity, sleep apnea, sedentary lifestyle, and diabetes mellitus are among the prominent risk factors for AF. Consequently, it becomes paramount to analyze detection methods and appropriate treatments for this pathology in order to mitigate serious complications. Among the available treatment modalities, antiarrhythmic medications and catheter ablation are the most widely used therapeutic approaches. A systematic review was conducted to evaluate the differences in recurrence rates of atrial fibrillation between patients undergoing ablation procedure and patients undergoing pharmacological treatment. Searches in the PubMed and SciELO databases were executed, focusing on clinical studies published from 2020 to 2024 that evaluated outcomes related to AF symptoms in patients subjected to either ablation or pharmacotherapy. In total, seven clinical studies were selected and analyzed according to eligibility criteria, in which three studies comparing radiofrequency ablation and four studies comparing cryoablation with Class I and III antiarrhythmics medications. The recurrence of AF across all studies was lower in the ablation procedure compared to the pharmacological treatment, thereby demonstrating more effectiveness in reducing AF symptoms through the ablation procedure.
Atrial fibrillation (AF) represents the most prevalent cardiac arrhythmia and it is associated with an increased mortality rate, as well as heightened risks of heart failure, cerebrovascular accidents (CVA), and late cognitive impairment. Advancing age, obesity, sleep apnea, sedentary lifestyle, and diabetes mellitus are among the prominent risk factors for AF. Consequently, it becomes paramount to analyze detection methods and appropriate treatments for this pathology in order to mitigate serious complications. Among the available treatment modalities, antiarrhythmic medications and catheter ablation are the most widely used therapeutic approaches. A systematic review was conducted to evaluate the differences in recurrence rates of atrial fibrillation between patients undergoing ablation procedure and patients undergoing pharmacological treatment. Searches in the PubMed and SciELO databases were executed, focusing on clinical studies published from 2020 to 2024 that evaluated outcomes related to AF symptoms in patients subjected to either ablation or pharmacotherapy. In total, seven clinical studies were selected and analyzed according to eligibility criteria, in which three studies comparing radiofrequency ablation and four studies comparing cryoablation with Class I and III antiarrhythmics medications. The recurrence of AF across all studies was lower in the ablation procedure compared to the pharmacological treatment, thereby demonstrating more effectiveness in reducing AF symptoms through the ablation procedure.
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