Catheter Ablation Compared with Medical Therapy for Atrial Fibrillation with Heart Failure: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Background: The optimal strategy for patients with coexisting atrial fibrillation (AF) and heart failure (HF) was not settled. Our purpose was to conduct a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of catheter ablation compared with medical therapy for AF on mortality, HF hospitalization, left ventricular (LV) function, and quality of life among patients with HF and AF. Materials and Methods: We searched Pubmed (1966 to September 20, 2019), EMBASE (1966 to September 20, 2019), the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov for randomized controlled trials with a comparison of catheter ablation for AF with medical therapy among patients with coexisting AF and HF. Risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) was used as a measure of the effect of catheter ablation versus medical therapy on endpoints. Our final analysis included 6 randomized control trials with 775 patients. Results: Pooled results from the random-effects model showed that compared with medical therapy for AF, catheter ablation was associated with reduced all-cause mortality (RR 0.52, 95%Cl, 0.35 to 0.76) and HF hospitalization (RR 0.56, 95%Cl, 0.44 to 0.71), as well as increased LV ejection fraction (LVEF), distance walked in six minutes, and improvements in quality of life. Conclusions: This updated meta-analysis showed that compared to medical therapy, catheter ablation for AF was associated with significant benefits in several key clinical and biomarker endpoints, including reductions in all-cause mortality and HF hospitalization.

Keywords: atrial fibrillation; catheter ablation; heart failure; medical therapy; mortality..

Figure 1

Flowchart of study selection

Figure 2

Risk ratio with 95% confidence interval of all-cause mortality (catheter ablation for atrial fibrillation vs medical therapy), by trial and pooled. M-H indicates Mantel-Haenszel methods.

Figure 3

Risk ratio with 95% confidence interval of heart failure hospitalization and remained in atrial fibrillation (catheter ablation for atrial fibrillation vs medical therapy), by trial and pooled. HF: heart failure, AF: atrial fibrillation. M-H indicates Mantel-Haenszel methods.

Figure 4

Mean difference with 95% confidence interval in left ventricular ejection fraction (LVEF), 6-minute walk distance, and Minnesota Living with Heart Failure Questionnaire (MLHFQ), by trial and pooled.