April 13, 2017Journal of Innovations in Cardiac Rhythm ManagementOpen Access

Catheter Ablation of Atrial Fibrillation in Chronic Heart Failure: A Contemporary Review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Atrial fibrillation in chronic heart failure and specific cardiomyopathies (n=2233). Intervention: Catheter ablation of atrial fibrillation vs. Medical therapy or atrioventricular node ablation (in RCTs). Primary outcome: Maintenance of sinus rhythm (final success including redo procedures).

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Key result

Catheter ablation of atrial fibrillation in patients with chronic heart failure achieved a final success rate of 73% to 77% in maintaining sinus rhythm and significantly improved left ventricular ejection fraction.

Why the study?

Does catheter ablation of atrial fibrillation improve procedural safety, efficacy, functional class, and quality of life in patients with chronic heart failure?

Study Design

Type

Systematic Review (n=2,233)

Structured PICO

Does catheter ablation of atrial fibrillation improve procedural safety, efficacy, functional class, and quality of life in patients with chronic heart failure?

Population

Patients with chronic heart failure (CHF) and/or structural cardiomyopathies presenting with atrial fibrillation (AF)

Intervention

Catheter ablation of atrial fibrillation

Outcome

Procedural safety and efficacy

This systematic review summarizes the safety, efficacy, and clinical benefits of catheter ablation for atrial fibrillation in patients with chronic heart failure, providing an evidence-based perspective for optimizing patient selection and procedural protocols.

Limitations

Majority of available data is based on small observational single-center studies of a retrospective nature
The optimal approach to patients with advanced atrial remodeling still needs to be defined
The impact of AF ablation on hard outcomes, such as mortality and stroke incidence, still needs to be tested in prospective, randomized trials

Implication

Supports ablation for AF in chronic HF; confirms efficacy and LVEF benefits in aggregated evidence.

Abstract

Catheter ablation of atrial fibrillation (AF) is a widely recommended treatment for patients presenting with symptomatic AF refractory to pharmacological treatment. AF ablation is also becoming a therapeutic option for patients with chronic heart failure (CHF), on top of optimal medical treatment, as AF is related to a higher risk of death, the worsening of symptoms, and the progression of CHF in this patient cohort. The present systematic review describes all published experiences concerning the use of AF catheter ablation among CHF patients and/or patients with structural cardiomyopathies, in an effort to summarize procedural safety and efficacy in this specific setting. Moreover, the effects of AF ablation on functional class and quality of life, as well as the different procedural protocols available, are presented and discussed, aiming to provide an evidence-based clinical perspective to optimize indication and tailor procedural characteristics and endpoints to patients affected by CHF referred for AF ablation.

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Published by Journal of Innovations in Cardiac Rhythm Management · CC BY

Cite This Study

Matta et al. (2017) conducted a systematic review in Atrial fibrillation in chronic heart failure and specific cardiomyopathies (n=2,233). Catheter ablation of atrial fibrillation vs. Medical therapy or atrioventricular node ablation (in RCTs) was evaluated on Maintenance of sinus rhythm (final success including redo procedures). Catheter ablation of atrial fibrillation in patients with chronic heart failure achieved a final success rate of 73% to 77% in maintaining sinus rhythm and significantly improved left ventricular ejection fraction.

synapsesocial.com/papers/6a157562d64fa333899fb0fe https://doi.org/10.19102/icrm.2017.080304