Key result
Catheter ablation significantly reduced all-cause mortality in atrial fibrillation patients with heart failure compared to medical therapy (RR 0.40; 95% CI 0.37-0.44).
Why the study?
Catheter ablation is thought to improve outcomes in atrial fibrillation patients, but evidence needed updating regarding its effects irrespective of baseline heart failure.
Does catheter ablation reduce mortality and hospitalization in patients with atrial fibrillation irrespective of baseline heart failure compared to medical treatment?
Meta-Analysis (n=18,370)
Does catheter ablation reduce mortality and hospitalization in patients with atrial fibrillation irrespective of baseline heart failure compared to medical treatment?
Relative Risk: 0.4 (95% CI 0.37–0.44)
Catheter ablation is associated with significant reductions in mortality and hospitalizations in patients with atrial fibrillation, regardless of the presence or type of baseline heart failure.
Supports catheter ablation over medical therapy for lower mortality in AF irrespective of heart failure; extends evidence across HF strata.
Introduction Patients with atrial fibrillation (AF) are associated with higher morbidity and mortality. Catheter ablation (CA) is supposed to improve outcomes in these patients. We aimed to update the evidence regarding CA in AF patients irrespective of their baseline heart failure. Methods We searched PubMed, Scopus, WOS, and Cochrane until February 2024 for relevant studies assessing the impact of CA compared to medical regimens in AF patients with and without heart failure. Outcomes of interest were all-cause mortality, cardiovascular mortality, hospitalization for HF, hospitalization for other cardiovascular causes, and stroke. Results 13 studies were included with a total of 18370 patients. In HF patients, irrespective to their ejection fraction, CA was associated with a significant reduction in all-cause mortality (RR 0.40, 95%CI [0.37 to 0.44], cardiovascular mortality (RR 0.36, 95%CI [0.32 to 0.42]), hospitalization from HF (RR 0.65, 95%CI [0.51 to 0.82]), hospitalization from other cardiovascular causes (RR 0.71, 95%CI [0.57 to 0.89]), and the incidence of stroke (RR 0.55, 95%CI [0.50 to 0.62]). Also, six studies with a total of 2015 patients compared CA to medical treatment in AF patients with HFrEF and HFpEF. CA showed a significant reduction in all-cause mortality in HFpEF patients compared to HFrEF (RR 0.46, 95%CI [0.25 to 0.85]) with no significant differences in terms of other studied outcomes. Moreover, six studies compared CA to medical treatment in HF vs no HF with a total of 2931 patients. Patients with AF and no HF had a significant reduction in all-cause mortality (RR .041, 95%CI [0.20 to 0.80]), with no significant differences in stroke or AF recurrence. Conclusion Current evidence supports the use of catheter ablation in atrial fibrillation patients, irrespective of their baseline heart failure, to achieve lower mortality and hospitalization rates.all-cause mortalitycardiovascular mortality
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Mohamed et al. (2024) conducted a meta-analysis in Atrial fibrillation (n=18,370). Catheter ablation vs. Medical regimens was evaluated on All-cause mortality in heart failure patients (RR 0.40, 95% CI 0.37 to 0.44). Catheter ablation significantly reduced all-cause mortality in atrial fibrillation patients with heart failure compared to medical therapy (RR 0.40; 95% CI 0.37-0.44).
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