Key result
Catheter ablation reduced all-cause mortality compared with medical therapy (RR 0.53; 95% CI 0.37 to 0.76; P=0.0007) in patients with heart failure and atrial fibrillation.
Why the study?
The study was conducted to compare the efficacy of catheter ablation and medical therapy in patients with heart failure and atrial fibrillation.
Does catheter ablation reduce mortality and improve cardiac function compared to medical therapy in patients with heart failure and atrial fibrillation?
Meta-Analysis (n=1,131)
Does catheter ablation reduce mortality and improve cardiac function compared to medical therapy in patients with heart failure and atrial fibrillation?
Relative Risk: 0.53 (95% CI 0.37–0.76)
p-value: p=0.0007
Catheter ablation significantly reduces all-cause mortality and improves LVEF, exercise capacity, and quality of life compared to medical therapy in patients with concurrent heart failure and atrial fibrillation.
Supports ablation over medical therapy in HF with AF; confirms mortality benefit in meta-analysis of RCTs.
Objective. To compare the efficacy of catheter ablation and medical therapy in patients with heart failure and atrial fibrillation. Methods. We searched randomized controlled trials comparing catheter ablation versus medical therapy for heart failure and atrial fibrillation through PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, and China National Knowledge Infrastructure. Articles were investigated for their methodological quality using the Cochrane Collaboration risk of the bias assessment tool. Forest plots, funnel plots, and sensitivity analysis were also performed on the included articles. Results were expressed as risk ratio (RR) and mean difference (MD) with 95% confidence intervals. Results. Nine (9) studies were included in this study with 1131 patients. Meta-analysis showed a reduction in all-cause mortality from catheter ablation compared with medical therapy (RR = 0.53, 95% CI = 0.37 to 0.76; <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>P</a:mi> <a:mo>=</a:mo> <a:mn>0.0007</a:mn> </a:math> ) and improved left ventricular ejection fraction (LVEF) (MD = 6.45, 95% CI = 3.49 to 9.41; <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> <c:mo><</c:mo> <c:mn>0.0001</c:mn> </c:math> ), 6-minute walking time (6MWT) (MD = 28.32, 95% CI = 17.77 to 38.87; <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo><</e:mo> <e:mn>0.0001</e:mn> </e:math> ), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (MD = 8.19, 95% CI = 0.30 to 16.08; <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>P</g:mi> <g:mo>=</g:mo> <g:mn>0.04</g:mn> </g:math> ). Conclusion. Catheter ablation had a better improvement than medical treatment in left ventricular ejection fraction, cardiac function, and exercise ability for atrial fibrillation and heart failure patients.
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Zhu et al. (2021) conducted a meta-analysis in Heart failure and atrial fibrillation (n=1,131). Catheter ablation vs. Medical therapy was evaluated on All-cause mortality (RR 0.53, 95% CI 0.37 to 0.76, p=0.0007). Catheter ablation reduced all-cause mortality compared with medical therapy (RR 0.53; 95% CI 0.37 to 0.76; P=0.0007) in patients with heart failure and atrial fibrillation.
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