Response to Letter Regarding Article “Treatment of Atrial Fibrillation with Anti-Arrhythmic Drugs or Radiofrequency Ablation: Two Systematic Literature Reviews and Meta-Analyses”

We are grateful to Brodsky for his thoughtful comments on our manuscript as well as his suggestions for the design of future prospective trials comparing the safety and efficacy of catheter ablation as compared with antiarrhythmic drug (AAD) therapy in the treatment of patients with atrial fibrillation (AF). We agree completely with many of the points that were raised by Brodsky. In particular, we agree that the outcomes of treatment of AF are likely to vary considerably in patients with paroxysmal and persistent AF. This is particularly true in patients with longstanding persistent AF (continuous AF lasting 12 months or longer).1 We also agree with Brodsky that many of the trials of AAD therapy evaluated in our meta-analysis were performed earlier than the trials of AF ablation. This point is presented clearly in Figures 4 through 7 of our article, which list each manuscript and the date of publication. Because of this difference, we cannot exclude the possibility that an increased use of background therapy with angiotensin-converting enzyme inhibitors, β-blockers, lipid-lowering agents, and systemic anticoagulation over time may have contributed to the apparent …