Catheter ablation for atrial fibrillation in heart failure with reduced ejection fraction patients: A meta-analysis

Abstract

BackgroundThe optimal treatment of atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF) remains unsettled. ObjectiveThe purpose of this study was to assess the efficacy of catheter ablation (CA) and medical therapy compared to medical therapy alone in patients with AF and HFrEF. MethodsWe performed a systematic review of randomized controlled trials (RCTs) comparing CA with guideline-directed medical therapy for AF in patients with HFrEF (left ventricular ejection fraction [LVEF] ≤ 40%). We systematically searched PubMed, Embase, and Cochrane for eligible trials. A random effects model was used to calculate the risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). ResultsSix RCTs comprising 1055 patients were included, of whom 530 (50.2%) were randomized to CA. Compared with medical therapy, CA was associated with a significant reduction in heart failure (HF) hospitalization (RR 0.57; 95% CI 0.45–0.72; P < .01), cardiovascular mortality (RR 0.46; 95% CI 0.31–0.70; P < .01), all-cause mortality (RR 0.53; 95% CI 0.36–0.78; P < .01), and AF burden (MD –29.8%; 95% CI –43.73% to –15.90%; P < .01). Also, there was a significant improvement in LVEF (MD 3.8%; 95% CI 1.6%–6.0%; P < .01) and quality of life (Minnesota Living with Heart Failure Questionnaire; MD –4.92 points; 95% CI –8.61 to –1.22 points; P < .01) in the ablation group. ConclusionIn this meta-analysis of RCTs of patients with AF and HFrEF, CA was associated with a reduction in HF hospitalization, cardiovascular mortality, and all-cause mortality as well as a significant improvement in LVEF and quality of life.