Meta-analysis of comprehensive prognostic evaluation in patients with atrial fibrillation complicated by heart failure after catheter ablation

Atrial fibrillation (AF) and heart failure (HF) often coexist, posing increased risks of HF events, rehospitalization, mortality, and stroke. While antiarrhythmic drugs have limitations, catheter ablation (CA) has emerged as a preferred rhythm control treatment for AF, yet its clinical outcomes remain inconclusive. Previous meta-analyses have predominantly included randomized controlled trials (RCTs) or cohort studies with limited sample sizes and outcome measures, which do not comprehensively and accurately reflect the clinical prognosis of patients with AF and HF following CA. However, the high prevalence of AF and HF comorbidity and the significant economic burden it imposes underscore the importance of focusing on the clinical prognosis of these patients. This meta-analysis systematically includes high-quality RCTs and cohort studies in evidence-based medicine, comprising a total of 34 studies and 777,668 patients.Meta-analysis revealed that CA significantly reduced the risk of HF events (RR, 0.63; 95% CI, 0.51-0.77), cardiovascular (CV) mortality (RR, 0.54; 95% CI, 0.45-0.66), CV hospitalization (RR, 0.81; 95% CI, 0.71-0.93), all-cause mortality (RR, 0.57; 95% CI, 0.46-0.70), all-cause rehospitalization (RR, 0.87; 95% CI, 0.76-0.996),AF recurrence (RR, 0.45; 95% CI, 0.36-0.57), and stroke (RR, 0.69; 95% CI, 0.57-0.83) when compared to NCA. CA demonstrated superior benefits in improving outcomes for patients with AF and HF, including HF events, mortality, rehospitalization, AF recurrence and incidence of stroke. Additionally, CA shows similar therapeutic effects in improving cardiac structure, cardiopulmonary function, and quality of life.These findings support the efficacy of CA in managing AF and HF.