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

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±11years, 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; I2=87%; p<0.001), greater increase in 6MWT distance (MD 25.1 metres; 95% CI, 0.6-50; I2=94%; p=0.04), improved QoL with greater reduction in MLHFQ scores (MD 9.03; 95% CI, 2.5-15.6; I2=47%; p=0.007), and significantly reduced mid-term mortality (relative risk 0.52; 95% CI, 0.4-0.8; I2=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.

• Authors: Sohaib A Virk, Richard G Bennett, Clara Chow, Prashanthan Sanders, Jonathan M Kalman, Stuart Thomas, Saurabh Kumar
• Journal: Heart, lung & circulation (Heart Lung Circ) Vol. 28 Issue 5 Pg. 707-718 (May 2019) ISSN: 1444-2892 [Electronic] Australia
• PMID: 30509786 (Publication Type: Journal Article, Meta-Analysis, Review)
• Copyright: Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

Chemical References

• Anti-Arrhythmia Agents

Topics

• Anti-Arrhythmia Agents (therapeutic use)
• Atrial Fibrillation (complications, physiopathology, therapy)
• Atrioventricular Node (physiopathology)
• Catheter Ablation (methods)
• Heart Failure (complications, physiopathology, therapy)
• Humans
• Randomized Controlled Trials as Topic
• Ventricular Function, Left (physiology)