Impact of atrial fibrillation catheter ablation on mortality, stroke, and heart failure hospitalizations: A meta‐analysis

Background The impact of atrial fibrillation catheter ablation (AFCA) on hard clinical endpoints remains controversial. Objective Our aim was to conduct a random‐effect model meta‐analysis on efficacy data from high‐quality large matched database/registry studies and randomized clinical trials. We compared long‐term all‐cause mortality, stroke, and hospitalization for heart failure in patients undergoing AFCA vs patients treated with medical therapy alone (rhythm and/or rate control medications) in a general AF population. Methods and Results PubMed/MEDLINE and Embase databases were screened and a total of nine studies were selected (one randomized clinical trial—CABANA—and eight large matched population studies). A total of 241 372 patients (27 711 in the ablation group, 213 661 in the nonablation group) were included. After a median follow‐up of 3.5 years, AFCA decreased the risk of mortality (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.54‐0.72; I 2 = 54%; number needed to treat [NNT] = 28), stroke (HR, 0.63; 95% CI, 0.56‐0.70; I 2 = 23%; NNT = 59) and hospitalization for heart failure (HR, 0.64; 95% CI, 0.51‐0.80; I 2 = 28%; NNT = 33) compared with AF patients treated with medical therapy alone. Conclusion Based on the currently available efficacy and effectiveness evidence, AFCA significantly reduces the risk of death, stroke, and hospitalization compared with medical therapy alone.