Key result
Catheter ablation reduces all-cause mortality ~35% vs medical treatment in AF and HF patients.
Why the study?
Increasing evidence suggested improved outcomes with catheter ablation versus medical therapy in patients with AF and heart failure, prompting an investigation into its clinical benefits.
Does catheter ablation reduce all-cause mortality in patients with atrial fibrillation and heart failure compared to medical therapy?
Meta-Analysis (n=2,121)
Does catheter ablation reduce all-cause mortality in patients with atrial fibrillation and heart failure compared to medical therapy?
Effect estimate: RR 0.65 (95% CI 0.51-0.83)
Absolute Event Rate: 8.8% vs 13.5%
p-value: p=.0005
Catheter ablation significantly reduces all-cause mortality and atrial arrhythmia recurrence, and improves LVEF in patients with atrial fibrillation and heart failure compared to medical therapy.
Supports ablation to lower mortality in AF with HF; reinforces and extends RCT evidence.
INTRODUCTION: Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) patients with heart failure (HF) undergoing catheter ablation (CA) as compared to medical therapy. We sought to investigate the benefit of CA on outcomes of patients with AF and HF as compared to medical therapy. METHODS AND RESULTS: A systematic review of PubMed, Embase, and Cochrane Central Register of Clinical Trials was performed for clinical studies evaluating the benefit of CA for patients with AF and HF. Primary endpoint was all-cause mortality. Secondary endpoints included atrial-arrhythmia recurrence and improvement in left ventricular ejection fraction (LVEF). Eight randomized controlled trials were included with a total of 2121 patients (mean age: 65 ± 5 years; 72% male). Mean follow-up duration was 32.9 ± 14.5 months. All-cause mortality in patients who underwent CA was significantly lower than in the medical treatment group (8.8% vs. 13.5%, RR 0.65, 95% confidence interval [CI] 0.51-0.83, p = .0005). A 35% relative risk reduction and 4.7% absolute risk reduction in all-cause mortality was observed with CA. Rates of all-atrial arrhythmia recurrence were significantly lower in the CA group (39.9% vs. 69.6%, RR: 0.55, 95% CI: 0.40-0.76, p = .0003). Improvement in LVEF was significantly higher in patients undergoing CA (+9.4 ± 7.6%) as compared to conventional treatment (+3.3 ± 8%) (mean difference 6.2, 95% CI: 3.6-8.8, p < .00001). CONCLUSION: CA for AF in patients with HF decreases all-cause mortality, improves all-atrial arrhythmia recurrence rate and LVEF when compared to medical management. CA should be considered the treatment of choice to improve survival in this select group of patients. Nonetheless, the benefit of CA in patients with severely reduced ejection fraction and New York Heart Association class IV HF has not been clearly elucidated.
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Romero et al. (2022) conducted a meta-analysis in Atrial fibrillation and heart failure (n=2,121). Catheter ablation vs. Medical treatment was evaluated on All-cause mortality (RR 0.65, 95% CI 0.51-0.83, p=.0005). Catheter ablation significantly reduced all-cause mortality compared to medical treatment in patients with atrial fibrillation and heart failure (8.8% vs. 13.5%, RR 0.65; 95% CI 0.51-0.83; p=0.0005).
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