Catheter Ablation Versus Medical Therapy for Atrial Fibrillation in Patients With Heart Failure: A Meta-Analysis of Randomised Controlled Trials

Sohaib A. Virk, Richard G. Bennett, Clara Chow, Prash Sanders, Jonathan M. Kalman, Stuart Thomas, Saurabh Kumar

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Catheter ablation (CA) is highly efficacious for symptomatic atrial fibrillation (AF) but data predominantly comes from patients with preserved ventricular function. We performed an updated systematic review and meta-analysis of randomised controlled trials (RCT) comparing CA versus medical therapy for AF associated with heart failure (HF). Methods: Medline, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for RCTs reporting clinical outcomes of CA versus medical therapy for AF in HF patients with ≥6 months’ follow-up (atrioventricular-node ablation/device therapy studies excluded). Primary endpoint was change in left ventricular ejection fraction (LVEF). Secondary endpoints were 6-minute walk test (6MWT) distance, quality of life (QoL; measured by the Minnesota Living with Heart Failure Questionnaire [MLHFQ]), peri-procedural mortality, major peri-procedural complications and mid-term (≥1-year) survival. Results: Six RCTs (n = 772 patients; mean age 62 ± 11 years, LVEF 30 ± 9%) were included. Catheter ablation, compared to medical therapy was associated with: greater improvement in LVEF (mean difference [MD] 5.67%; 95% Confidence Interval [CI], 3–8; I 2 = 87%; p < 0.001), greater increase in 6MWT distance (MD 25.1 metres; 95% CI, 0.6–50; I 2 = 94%; p = 0.04), improved QoL with greater reduction in MLHFQ scores (MD 9.03; 95% CI, 2.5–15.6; I 2 = 47%; p = 0.007), and significantly reduced mid-term mortality (relative risk 0.52; 95% CI, 0.4–0.8; I 2 = 0%; p = 0.001). Freedom from AF after ≥1 procedure was 71%; major complications occurred in 8% of patients. Conclusion: Catheter ablation is superior to medical therapy for AF in patients with heart failure resulting in greater improvement in LVEF, quality of life and functional status, with a survival benefit.

Original languageEnglish
Pages (from-to)707-718
Number of pages12
JournalHeart Lung and Circulation
Volume28
Issue number5
DOIs
Publication statusPublished - 1 May 2019

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Medical therapy
  • Mortality
  • Quality of life
  • Randomised controlled trials

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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