Key result
Catheter ablation in AF and HFmrEF is linked to ~91% lower HF hospitalization and mortality vs medical therapy.
Why the study?
The efficacy of catheter ablation on clinical outcomes and cardiac structural remodelling in atrial fibrillation patients with HFmrEF remains unclear.
Does catheter ablation reduce heart failure hospitalization and all-cause mortality in patients with atrial fibrillation and HFmrEF compared to medical therapy?
Cohort (n=144)
Does catheter ablation reduce heart failure hospitalization and all-cause mortality in patients with atrial fibrillation and HFmrEF compared to medical therapy?
Effect estimate: HR 0.089 (95% CI 0.011-0.747)
p-value: p=0.026
In patients with atrial fibrillation and HFmrEF, catheter ablation is associated with significantly reduced heart failure hospitalization, lower all-cause mortality, and improved cardiac structural remodeling compared to medical therapy.
May support ablation in AF with HFmrEF; leaves open need for randomized confirmation before practice change.
AIMS: The efficacy of catheter ablation (CA) on clinical outcomes and cardiac structural remodelling in atrial fibrillation (AF) patients with HF with mildly reduced or mid-range ejection fraction (HFmrEF) remains unclear. We aimed to compare the efficacy of CA with medical therapy (MT) in AF patients with HFmrEF. METHODS AND RESULTS: We retrospectively screened a total of 36 879 patients with AF between 2005 and 2020. Patients who were initially diagnosed with echocardiography-proved HFmrEF and had follow-up echocardiography were enrolled. After applying propensity score matching in a 1:1 ratio, 72 patients treated by CA (Group 1) and 72 patients receiving MT (Group 2) were taken into further analysis. The co-morbidities were similar between the two groups, except for hyperlipidaemia. After a mean follow-up duration of 58.9 ± 42.6 months, Group 1 had a lower HF hospitalization and all-cause mortality compared with Group 2 (hazard ratio (HR), 0.089 [95% confidence interval (CI), 0.011-0.747]; P = 0.026 and HR, 0.121 [95% CI, 0.016-0.894]; P = 0.038, respectively). As for cardiac structural remodelling, the Group 1 had a better improvement in left ventricular ejection fraction (LVEF) and a more decreased left atrium (LA) diameter than Group 2 (+25.0% ± 18.0% vs. +6.2% ± 21.6%, P = <0.0001 and -1.6 ± 4.7 mm vs. +1.5 ± 8.2 mm, P = 0.008, respectively). CONCLUSIONS: In patients with HFmrEF and AF, CA of AF could reduce both HF hospitalization and all-cause mortality as compared with those with MT. A significant improvement in LVEF and decrease in LA diameter were also observed in the CA group. Early rhythm control with CA should be taken into consideration in patients with HFmrEF and AF.
No takes yet. Share an insight, caveat, or question.
Lee et al. (2022) conducted a cohort in Atrial fibrillation with heart failure with mildly reduced or mid-range ejection fraction (HFmrEF) (n=144). Catheter ablation vs. Medical therapy was evaluated on Heart failure hospitalization (HR 0.089, 95% CI 0.011-0.747, p=0.026). Catheter ablation in patients with AF and HFmrEF significantly reduced HF hospitalization (HR 0.089; 95% CI 0.011-0.747; P=0.026) and all-cause mortality compared to medical therapy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: