Abstract
Heart failure (HF) in the presence of atrial fibrillation (AF) is associated with worse outcomes including increased mortality risk. Catheter ablation (CA) is an increasingly used method of rhythm control in patients with AF. Most of the randomized clinical trials (RCT) evaluating CA in patients with AF and left ventricular systolic dysfunction (LVSD) were small, limiting their ability to draw conclusions. Recent multicenter RCTs have shown CA in patients with AF and LVSD to reduce mortality, and rates of hospitalization for worsening HF. We performed a systematic review and meta-analysis to evaluate the effects of CA in patients with AF and LVSD.
We conducted a systematic review of PubMed, EMBASE, and Cochrane Central databases, in addition to a manual search, for RCTs employing CA in patients with AF and LVSD. Statistical analysis was performed with random-effects model. Mortality was the primary outcome whereas unplanned hospitalizations, HF readmissions, change in left ventricular ejection fraction (LVEF) and freedom from AF at follow-up were secondary outcomes.
Seven publications met our inclusion criteria, which included a total of 846 patients for analysis (429 in CA arm and 427 in control arm). Compared to control, CA significantly reduced mortality [odds ratio (OR): 0.46; 95% confidence interval (CI): 0.29–0.72; P<0.001; I2=0] and HF readmissions [OR: 0.47; 95% CI: 0.30–0.75; P = 0.001; I2=0]. CA significantly improved LVEF [mean difference (MD): 7.53%; 95% CI: 3.67–11.4%; P=0.0001; I2=96%] and resulted in higher freedom from AF [70.6% vs. 18.5%; OR: 33.11; 95% CI: 9.76–112.37; P <0.00001; I2=80%]. Unplanned hospitalizations for any cause were similar between the two groups [0.54; 0.23–1.3; P = 0.17; I2=68].
Catheter ablation in patients with atrial fibrillation and heart failure results in reduced mortality and heart failure readmissions.