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Meta-Analysis
. 2019 Jan 15;19(1):18.
doi: 10.1186/s12872-019-0998-2.

Catheter ablation for atrial fibrillation in heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials

Ahmed AlTurki  1 , Riccardo Proietti  2 , Ahmed Dawas  1 , Hasan Alturki  3 , Thao Huynh  1 , Vidal Essebag  4   5
Affiliations
Meta-Analysis

Catheter ablation for atrial fibrillation in heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials

Ahmed AlTurki et al. BMC Cardiovasc Disord. .

Abstract

Background: Previous randomized controlled trials (RCT)s showed similar outcomes in patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) treated with anti-arrhythmic drugs (AAD) compared to rate control therapy. We sought to evaluate whether catheter ablation is superior to medical therapy in patients with AF and HFrEF.

Methods: We searched electronic databases for all RCTs that compared catheter ablation and medical therapy (with or without use of AAD). We used random-effects models to summarize the studies. The primary end-point was all-cause mortality. Secondary outcomes included heart failure-related hospitalizations and change in left ventricular ejection fraction (LVEF).

Results: We retrieved and summarized 7 randomized controlled trials, enrolling 856 patients (429 in the catheter ablation arm and 427 in the medical therapy arm). Compared with medical therapy (including use of AAD), AF catheter ablation was associated with a significant reduction in mortality (risk ratio 0.50; 95% confidence interval [CI]: 0.34 to 0.74; P = 0.0005) and heart failure-related hospitalizations (risk ratio 0.56; 95% CI: 0.44 to 0.71; P < 0.0001). Furthermore, catheter ablation led to significant improvements in LVEF (weighted mean difference, 7.48; 95% CI: 3.71 to 11.26; P < 0.0001).

Conclusions: Compared to medical therapy, including use of AAD, catheter ablation for AF was associated with a significant reduction in mortality and heart failure-related hospitalizations as well as an improvement in LVEF in patients with HFrEF. Larger trials are needed to confirm whether rhythm control with ablation is superior to rate control in patients with AF and heart failure.

Keywords: Atrial fibrillation; Catheter ablation; Heart failure.

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Conflict of interest statement

Ethics approval and consent to participate

This study used data from previously published studies that individually obtained ethics approval.

Consent for publication

Not applicable

Competing interests

Dr. Essebag has received honoraria from Abbott, biosense medical, boston scientific and Medtronic.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analyses flow diagram
Fig. 2
Fig. 2
Funnel plot for (a) mortality, (b) heart failure-related hospitalization, (c) change in left ventricular ejection fraction, (d) change in six-minute walk test, (e) change in Minnesota living with heart failure questionnaire score
Fig. 3
Fig. 3
Forest plot showing random effects summary of all-cause mortality
Fig. 4
Fig. 4
Forest plot showing random effects summary of heart failure hospitalization
Fig. 5
Fig. 5
Forest plot demonstrating random effects summary of change in LVEF
Fig. 6
Fig. 6
Forest plot showing random effects summary of change in six-minute walk test distance
Fig. 7
Fig. 7
Forest plot showing random effects summary of change in Minnesota Living With Heart Failure Questionnaire score
See this image and copyright information in PMC

References

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