What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial fibrillation with heart failure (n=775). Intervention: Catheter ablation vs. Medical therapy. Primary outcome: All-cause mortality (RR 0.52, 95% CI 0.35 to 0.76).

January 1, 2021International Journal of Medical SciencesOpen Access

Catheter Ablation Compared with Medical Therapy for Atrial Fibrillation with Heart Failure: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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Key result

Catheter ablation for atrial fibrillation reduced all-cause mortality by 48% (RR 0.52) compared with medical therapy in patients with coexisting heart failure.

Why the study?

The optimal management strategy for patients with coexisting atrial fibrillation and heart failure remained unsettled.

Does catheter ablation reduce all-cause mortality and heart failure hospitalization compared with medical therapy in patients with coexisting atrial fibrillation and heart failure?

Study Design

Type

Meta-Analysis (n=775)

Structured PICO

Does catheter ablation reduce all-cause mortality and heart failure hospitalization compared with medical therapy in patients with coexisting atrial fibrillation and heart failure?

Population

775 patients with coexisting atrial fibrillation and heart failure from 6 randomized controlled trials, followed for 6 to 38 months.

Intervention

Catheter ablation for atrial fibrillation

Comparator

Medical therapy for rate and/or rhythm control (including rate control, amiodarone, or guideline-directed medical therapy)

Outcome

All-cause mortalityhard clinical

Main Result

Relative Risk: 0.52 (95% CI 0.35–0.76)

Number Needed to Treat: 12

Catheter ablation for atrial fibrillation in patients with heart failure significantly reduces all-cause mortality and heart failure hospitalizations compared to medical therapy.

Limitations

Meta-analysis may be biased if the literature search failed to identify all relevant trials.
Follow-up duration in most of the included trials was less than one year, which is less likely to capture mortality endpoints.
Success of catheter ablation relies largely on experienced operators, which may limit generalizability to real-world practice.
Meta-analysis may be biased when the literature search fails to identify all relevant trials
Follow-up duration in most of the included trials were less than one year which is less likely to include mortality endpoint
Success of catheter ablation for AF relies largely on experienced operators

Implication

Supports ablation over medical therapy in AF with HF; confirms mortality benefit across pooled RCTs.

Abstract

The optimal strategy for patients with coexisting atrial fibrillation (AF) and heart failure (HF) was not settled. Our purpose was to conduct a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of catheter ablation compared with medical therapy for AF on mortality, HF hospitalization, left ventricular (LV) function, and quality of life among patients with HF and AF.

Discussion

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Published by International Journal of Medical Sciences · CC BY

Cite This Study

Pan et al. (2021) conducted a meta-analysis in Atrial fibrillation with heart failure (n=775). Catheter ablation vs. Medical therapy was evaluated on All-cause mortality (RR 0.52, 95% CI 0.35 to 0.76). Catheter ablation for atrial fibrillation reduced all-cause mortality by 48% (RR 0.52) compared with medical therapy in patients with coexisting heart failure.

synapsesocial.com/papers/6a7481ab0081fe7b05dbd900 https://doi.org/10.7150/ijms.52257