Key result
Catheter ablation reduces mortality and HF hospitalization ~35% versus medical therapy.
Why the study?
AF and HF often coexist and synergistically increase the risk of hospitalization, stroke, and mortality, prompting an evaluation of catheter ablation versus medical therapy.
Does catheter ablation reduce the composite of all-cause mortality and HF hospitalization in patients with atrial fibrillation and heart failure compared to medical therapy?
Meta-Analysis (n=2,155)
Does catheter ablation reduce the composite of all-cause mortality and HF hospitalization in patients with atrial fibrillation and heart failure compared to medical therapy?
Relative Risk: 0.65 (95% CI 0.53–0.8)
Absolute Event Rate: 24.6% vs 37.1%
p-value: p=<0.0001
Catheter ablation is superior to medical therapy in reducing mortality and heart failure hospitalizations, while also improving functional capacity and quality of life in patients with coexisting atrial fibrillation and heart failure.
Supports preferring catheter ablation over medical therapy in selected HF patients with AF; confirms reductions in mortality and HF events across pooled RCTs.
Background Atrial fibrillation (AF) and heart failure (HF) often coexist and syner-gistically contribute to an increased risk of hospitalization, stroke, and mortality. Objective: To compare the efficacy of catheter ablation (CA) versus medical therapy (MT) in HF patients with AF. Methods Electronic databases were queried for randomized controlled trials (RCTs) of CA versus MT of AF in patients with HF. Risk ratios (RRs), mean differences (MDs), and 95% confidence in-tervals (CIs) were measured using the Mantel–Haenszel method. Results A total of nine RCTs enrolling 2155 patients met the inclusion criteria. Compared to MT, CA led to a significant reduction in the composite of all-cause mortality and HF hospitalization (24.6% vs. 37.1%; RR: 0.65 (95% CI: 0.53–0.80); p < 0.0001) (Figure 1), all-cause mortality (8.8% vs. 13.6%; RR: 0.65 (95% CI: 0.51–0.82); p = 0.0005), HF hospitalization (15.4% vs. 22.4%; (RR: 0.67 (95% CI: 0.54–0.82); p = 0.0001), AF re-currence (31.8% vs. 77.0%; RR: 0.36 (95% CI: 0.24–0.54); p < 0.0001), and cardiovascular (CV) death (4.9% vs. 8.4%; RR: 0.58 (95% CI: 0.39–0.86); p = 0.007). CA improved the left ventricular ejection fraction (MD:4.76% (95% CI: 2.35–7.18); p = 0.0001), 6 min walk test (MD: 20.48 m (95% CI: 10.83–30.14); p < 0.0001), peak oxygen consumption (MD: 3.1 2mL/kg/min (95% CI: 1.01–5.22); p = 0.004), Minnesota Living with Heart Failure Questionnaire score (MD: −6.98 (95% CI: −12–03, −1.93); p = 0.007), and brain natriuretic peptide levels (MD:−133.94 pg/mL (95% CI: −197.33, −70.55); p < 0.0001). Conclusions In HF patients, AF catheter ablation was superior to MT in re-ducing CV and all-cause mortality. Further significant benefits occurred within the ablation group in terms of HF hospitalizations, AF recurrences, the systolic function, exercise capacity, and quality of life. Figure 1: Forest plot displaying a decrease in the composite endpoint in patients with AF and HF undergoing CA versus MT.
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Magnocavallo et al. (2022) conducted a meta-analysis in Atrial fibrillation and heart failure (n=2,155). Catheter ablation vs. Medical therapy was evaluated on Composite of all-cause mortality and HF hospitalization (RR 0.65, 95% CI 0.53-0.80, p=<0.0001). Catheter ablation significantly reduced the composite of all-cause mortality and heart failure hospitalization compared to medical therapy (24.6% vs. 37.1%; RR 0.65, 95% CI 0.53-0.80; P<0.0001).
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