Key result
Catheter ablation cuts mortality and HF hospitalization ~35% vs medical therapy in HF patients.
Why the study?
AF and HF often coexist and synergistically increase the risk of hospitalization, stroke, and mortality, prompting an evaluation of CA versus MT.
Does catheter ablation reduce the composite of all-cause mortality and HF hospitalization in patients with heart failure and atrial fibrillation compared to medical therapy?
Meta-Analysis (n=2,155)
Does catheter ablation reduce the composite of all-cause mortality and HF hospitalization in patients with heart failure and atrial fibrillation compared to medical therapy?
Effect estimate: RR 0.65 (95% CI 0.53-0.80)
Absolute Event Rate: 24.6% vs 37.1%
p-value: p=<0.0001
In patients with coexisting heart failure and atrial fibrillation, catheter ablation is superior to medical therapy in reducing mortality, heart failure hospitalizations, and improving functional capacity.
Supports catheter ablation over medical therapy in HF with AF; confirms mortality/HF hospitalization benefit in pooled RCTs.
Background: Atrial fibrillation (AF) and heart failure (HF) often coexist and synergistically contribute to an increased risk of hospitalization, stroke, and mortality. Objective: To compare the efficacy of catheter ablation (CA) versus medical therapy (MT) in HF patients with AF. Methods: Electronic databases were queried for randomized controlled trials (RCTs) of CA versus MT of AF in patients with HF. Risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) were measured using the Mantel−Haenszel method. Results: A total of nine RCTs enrolling 2155 patients met the inclusion criteria. Compared to MT, CA led to a significant reduction in the composite of all-cause mortality and HF hospitalization (24.6% vs. 37.1%; RR: 0.65 (95% CI: 0.53−0.80); p < 0.0001), all-cause mortality (8.8% vs. 13.6%; RR: 0.65 (95% CI: 0.51−0.82); p = 0.0005), HF hospitalization (15.4% vs. 22.4%; (RR: 0.67 (95% CI: 0.54−0.82); p = 0.0001), AF recurrence (31.8% vs. 77.0%; RR: 0.36 (95% CI: 0.24−0.54); p < 0.0001), and cardiovascular (CV) death (4.9% vs. 8.4%; RR: 0.58 (95% CI: 0.39−0.86); p = 0.007). CA improved the left ventricular ejection fraction (MD:4.76% (95% CI: 2.35−7.18); p = 0.0001), 6 min walk test (MD: 20.48 m (95% CI: 10.83−30.14); p < 0.0001), peak oxygen consumption (MD: 3.1 2mL/kg/min (95% CI: 1.01−5.22); p = 0.004), Minnesota Living with Heart Failure Questionnaire score (MD: −6.98 (95% CI: −12−03, −1.93); p = 0.007), and brain natriuretic peptide levels (MD:−133.94 pg/mL (95% CI: −197.33, −70.55); p < 0.0001). Conclusions: In HF patients, AF catheter ablation was superior to MT in reducing CV and all-cause mortality. Further significant benefits occurred within the ablation group in terms of HF hospitalizations, AF recurrences, the systolic function, exercise capacity, and quality of life.
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Magnocavallo et al. (2022) conducted a meta-analysis in Atrial fibrillation and heart failure (n=2,155). Catheter ablation vs. Medical therapy was evaluated on Composite of all-cause mortality and HF hospitalization (RR 0.65, 95% CI 0.53-0.80, p=<0.0001). Catheter ablation significantly reduced the composite of all-cause mortality and HF hospitalization compared to medical therapy (24.6% vs 37.1%; RR 0.65; 95% CI 0.53-0.80; p<0.0001) in HF patients.
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