Abstract
Objective To compare the efficacy of catheter ablation and medical therapy in patients with heart failure and atrial fibrillation. Methods We searched randomized controlled trials comparing catheter ablation versus medical therapy for heart failure and atrial fibrillation through PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, and China National Knowledge Infrastructure. Articles were investigated for their methodological quality using the Cochrane Collaboration risk of the bias assessment tool. Forest plots, funnel plots, and sensitivity analysis were also performed on the included articles. Results were expressed as risk ratio (RR) and mean difference (MD) with 95% confidence intervals. Results Nine (9) studies were included in this study with 1131 patients. Meta-analysis showed a reduction in all-cause mortality from catheter ablation compared with medical therapy (RR = 0.53, 95% CI = 0.37 to 0.76; P=0.0007) and improved left ventricular ejection fraction (LVEF) (MD = 6.45, 95% CI = 3.49 to 9.41; P < 0.0001), 6-minute walking time (6MWT) (MD = 28.32, 95% CI = 17.77 to 38.87; P < 0.0001), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (MD = 8.19, 95% CI = 0.30 to 16.08; P=0.04). Conclusion Catheter ablation had a better improvement than medical treatment in left ventricular ejection fraction, cardiac function, and exercise ability for atrial fibrillation and heart failure patients.
Highlights
Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases in the 21st century [1]. e incidence rate of AF is positively correlated with age, especially for elderly people; the prevalence rate in people over 80 years of age is 9%∼15% [2]
Some studies have shown that compared with ventricular rate control, the rhythm control of antiarrhythmic drugs in patients with AF combined with HF cannot effectively reduce the mortality of this population [8, 9]. e previous report shows that it is difficult to maintain the sinus rhythm with drugs and direct current cardioversion
Among the 9 articles, as the risk of atrial fibrillation and heart failure, studies were often unable to be completely blind and randomized [27], so high risk of selection bias existed in most included articles; in addition, high risk of reporting bias and selection bias of allocation were found in one study (Figure 2)
Summary
Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases in the 21st century [1]. e incidence rate of AF is positively correlated with age, especially for elderly people; the prevalence rate in people over 80 years of age is 9%∼15% [2]. AF can aggravate the risk of deterioration of heart function in patients with HF, accelerate the occurrence time of HF symptoms, and lead to severe limitation of daily activities and decline in quality of life [3, 4]. When AF occurs, hemodynamic changes, loss of effective atrial contraction, and rapid but irregular ventricular rate lead to reduced cardiac output and left ventricular dysfunction. Some studies have shown that compared with ventricular rate control, the rhythm control of antiarrhythmic drugs in patients with AF combined with HF cannot effectively reduce the mortality of this population [8, 9]. Erefore, for this kind of patient, the choice of antiarrhythmic drugs for maintaining sinus rhythm has great limitations [12, 13] Antiarrhythmic drugs have arrhythmogenic effects. eir arrhythmogenic effects will aggravate the HF of patients, so the benefits of drugs by converting to sinus rhythm will be offset by this arrhythmogenic effect [10, 11]. erefore, for this kind of patient, the choice of antiarrhythmic drugs for maintaining sinus rhythm has great limitations [12, 13]
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