Clinical efficacy of catheter ablation versus medical rate control among patients with atrial fibrillation across heart failure phenotypes: a meta-analysis of randomized controlled trials

Abstract

Abstract Background Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. It frequently co-exists with heart failure (HF) with complex dynamic interactions. Trials comparing rate and rhythm control strategies with the latter based on anti-arrhythmic drugs (AADs) failed to show benefit of one strategy over the other. Therefore, it is still unclear what constitutes an ideal AF management, especially in the context of HF. Objective To compare the clinical efficacy between catheter ablation and medical rate control among patients with atrial fibrillation and heart failure Study Selection Only randomized controlled trials (RCT) comparing catheter ablation and medical rate control in patients with atrial fibrillation and heart failure were selected for review. Methods Pubmed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) reporting clinical outcomes of catheter ablation versus medical rate control for AF in HF patients with > 6 months follow-up. Primary endpoint was change in left ventricular ejection fraction (LVEF). Secondary endpoints were 6-minute walk test (6MWT) distance, quality of life (QoL), BNP levels, and number of adverse events. Results Five RCTs with 615 patients were included in the analysis. Patients in the catheter ablation had greater improvement in LVEF (WMD 7.38, 95%CI: p < 0.001), longer 6-min walk distance (WMD 17.41, CI 95%: p < 0.0001), lower Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores (WMD -6.21, CI 95%: p < 0.00001), and lower BNP levels (WMD -113.1 ng/L, CI 95%: p < 0.00001), compared with medical rate control. However, catheter ablation group had higher rates of adverse events mostly from procedural complications (RR 2.2, CI 95%: p = 0.005). Conclusion Catheter ablation is superior to medical rate control in terms of LVEF improvement, increase in functional status, reduction in biomarker, and better quality of life among patients with AF and HF.