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. 2023 Jan 17;39(2):129-141.
doi: 10.1002/joa3.12812. eCollection 2023 Apr.

Prognostic benefit of catheter ablation of atrial fibrillation in heart failure: An updated meta-analysis of randomized controlled trials

Sohaib A Virk  1 , Karice Hyun  1   2 , David Brieger  1   3 , Raymond W Sy  1   3
Affiliations

Prognostic benefit of catheter ablation of atrial fibrillation in heart failure: An updated meta-analysis of randomized controlled trials

Sohaib A Virk et al. J Arrhythm. .

Abstract

Background: The prognostic role of catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) remains uncertain, with guideline recommendations largely based on a single trial. We conducted a meta-analysis of randomized controlled trials (RCTs) assessing the prognostic impact of AF ablation in patients with HF.

Methods: Electronic databases were searched for RCTs comparing 'AF ablation' versus 'other care' (medical therapy and/or atrioventricular node ablation with pacing) in patients with HF. Primary endpoints were ≥1-year mortality, HF hospitalization and change in left ventricular ejection fraction (LVEF). Meta-analyses were performed using random-effects modelling.

Results: Nine RCTs (n = 1462) met inclusion criteria. Compared to 'other care', AF ablation significantly reduced ≥1-year mortality (relative risk [RR] 0.65; 95% confidence intervals [CI], 0.49-0.87) and HF hospitalization (RR 0.64; 95% CI, 0.51-0.81). AF ablation demonstrated significantly greater improvement in LVEF (mean difference [MD] 5.4; 95% CI, 4.4-6.4), 6-min walk test distance (MD 21.5 meters; 95% CI, 4.6-38.4) and quality of life as measured by Minnesota Living with Heart Failure Questionnaire score (MD 7.2; 95% CI, 2.8-11.7). Meta-regression analyses showed the beneficial impact of AF ablation on LVEF was significantly blunted by higher prevalence of ischaemic cardiomyopathy.

Conclusions: Our meta-analysis demonstrates AF ablation is superior to 'other care' in improving mortality, HF hospitalization, LVEF and quality of life in patients with HF. However, the highly selected study populations in included RCTs and effect modification mediated by etiology of HF suggests these benefits do not uniformly apply across the HF population.

Keywords: atrial fibrillation; catheter ablation; heart failure; meta‐analysis.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Forest plot displaying relative risk (RR) for: (A) mid‐term mortality, and (B) heart failure hospitalisation, in patients with heart failure and atrial fibrillation (AF) undergoing AF ablation versus other care.
FIGURE 2
FIGURE 2
Forest plot displaying mean difference (MD) in left ventricular ejection fraction (LVEF) change in patients with heart failure and atrial fibrillation (AF) undergoing AF ablation versus other care.
FIGURE 3
FIGURE 3
Forest plot displaying mean difference (MD) in: (A) 6‐min walk test distance and (B) Minnesota living with heart failure questionnaire scores in patients with heart failure and atrial fibrillation (AF) undergoing AF ablation versus other care.
FIGURE 4
FIGURE 4
Scatterplot displaying regression of change in left ventricular ejection fraction (LVEF) on prevalence of ischaemic cardiomyopathy (CM) in randomized controlled trials comparing atrial fibrillation (AF) ablation versus other care in patients with AF and heart failur.
See this image and copyright information in PMC

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