Abstract
Background: Catheter ablation (CA) for atrial fibrillation (AF) has been proposed as a means of improving outcomes among patients with heart failure and reduced ejection fraction (HFrEF) who are otherwise receiving appropriate treatment. Unlike HFrEF, treatment options are more limited in patients with preserved ejection fraction (HFpEF) and the data pertaining to the management of AF in these patients are controversial. The aim of this systematic review and meta-analysis was to investigate the effects of CA on outcomes of patients with AF and HFpEF, such as functional status, post-procedural complications, hospitalization, morbidity and mortality, based on data from observational studies. Methods: We systematically searched the electronic databases MEDLINE, PUBMED, EMBASE and the Cochrane Library for Central Register of Clinical Trials until May 2020. Results: Overall, the pooling of our data showed that sinus rhythm was achieved long-term in 58.0% (95% CI 0.44–0.71). Long-term AF recurrence was noticed in 22.3% of patients. Admission for HF occurred in 6.2% (95% CI 0.04–0.09) whilst all-cause mortality was identified in 6.3% (95% CI 0.02–0.13). Conclusion: This meta-analysis is the first to focus on determining the benefits of a rhythm control strategy for patients with AF and HFpEF using CA, suggesting it may be worthwhile to investigate the effects of a CA rhythm control strategy as the default treatment of AF in HFpEF patients in randomized trials.
Highlights
The co-existence of heart failure (HF) with atrial fibrillation (AF) confers a poor prognosis, and the combination is frequently encountered given the overlap of predisposing risk factors, including older age, hypertension, metabolic syndrome, and diastolic dysfunction [1]
AF ablation which was the first procedure for 80.3% of the patients was shown to be quite a safe procedure in HFpEF patients with reasonable overall outcomes
Taking into consideration the similarities between heart failure and reduced ejection fraction (HFrEF) and HFpEF [28], it would be worthwhile to investigate the effects of rhythm control as the default treatment modality for AF in HFpEF patients via multi-centre randomized control trials
Summary
The co-existence of heart failure (HF) with atrial fibrillation (AF) confers a poor prognosis, and the combination is frequently encountered given the overlap of predisposing risk factors, including older age, hypertension, metabolic syndrome, and diastolic dysfunction [1] The causality between these entities is an area of ongoing research, but it follows that those patients with HF are likely to benefit from being in sinus rhythm versus. AF, as evidenced by improvements in functional status and potential mortality benefits [2] This relationship appears to hold for the various HF subtypes, including both HF with preserved (HFpEF) and HF with reduced (HFrEF) ejection fraction cohorts [1]. Conclusion: This meta-analysis is the first to focus on determining the benefits of a rhythm control strategy for patients with AF and HFpEF using CA, suggesting it may be worthwhile to investigate the effects of a CA rhythm control strategy as the default treatment of AF in HFpEF patients in randomized trials
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