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. 2022 Jan-Feb;22(1):18-23.
doi: 10.1016/j.ipej.2021.09.002. Epub 2021 Oct 5.

A comparison of clinical outcomes following atrial fibrillation ablation for heart failure patients with preserved or reduced left ventricular function: A systematic review and meta-analysis

Gaurav Panchal  1 , Chun Shing Kwok  2 , Adrian Morley-Davies  1 , Donah Zachariah  1 , Thanh Phan  1
Affiliations

A comparison of clinical outcomes following atrial fibrillation ablation for heart failure patients with preserved or reduced left ventricular function: A systematic review and meta-analysis

Gaurav Panchal et al. Indian Pacing Electrophysiol J. 2022 Jan-Feb.

Abstract

Background: This review aims to determine if patients who undergo atrial fibrillation (AF) ablation with heart failure with preserved ejection fraction (HFpEF) do better, or worse or the same compared to patients with heart failure with reduced ejection fraction (HFrEF).

Methods: A search of MEDLINE and EMBASE was performed using the search terms: "atrial fibrillation", "ablation" and terms related to HFpEF and HFrEF in order to identify studies that evaluated one or more of i) AF recurrence, ii) periprocedural complications and iii) adverse outcomes at follow up for patients with HFpEF and HFrEF who underwent AF ablation. Data was extracted from included studies and statistically pooled to evaluate adverse events and AF recurrence.

Results: 5 studies were included in this review and the sample size of the studies ranged from 91 to 521 patients with heart failure. There was no significant difference in the pooled rate for no AF or symptom recurrence after AF ablation comparing patients with HFpEF vs HFrEF (RR 1.07 95%CI 0.86-1.33, p = 0.15). The most common complications were access site complications/haematoma/bleeding which occurred in similar proportion in each group; HFpEF (3.1%) and HFrEF (3.1%). In terms of repeat ablations, two studies were pooled to yield a rate of 78/455 (17.1%) for HFpEF vs 24/279 (8.6%) for HFrEF (p = 0.001.

Conclusions: Heart failure patients with preserved or reduced ejection fraction have similar risk of AF or symptom recurrence after AF ablation but two studies suggest that patients with HFpEF are more likely to have repeat ablations.

Keywords: Ablation; Atrial fibrillation; Heart failure with preserved ejection fraction; Heart failure with reduced ejection fraction.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection.
Fig. 2
Fig. 2
Meta-analysis of atrial fibrillation recurrence or good outcome for patients with HFpEF vs HFrEF who undergo atrial fibrillation ablation∗.
See this image and copyright information in PMC

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