Radiofrequency catheter ablation significantly reduced all-cause mortality and HF hospitalization compared to medical therapy in patients with AF and LVEF <50%, but not in those with LVEF ≤35%.
Meta-Analysis
Does radiofrequency catheter ablation improve clinical outcomes in heart failure patients with atrial fibrillation and impaired left ventricular systolic function (LVEF <50%) compared with medical therapy?
Radiofrequency catheter ablation improves clinical, structural, and functional outcomes in heart failure patients with atrial fibrillation and LVEF <50%, though mortality benefits may not extend to those with severely reduced LVEF (≤35%).
BACKGROUND: The recent Atrial Fibrillation Management in Congestive Heart Failure With Ablation trial did not reveal any benefit of catheter ablation in patients with atrial fibrillation (AF), advanced heart failure (HF), and severely reduced left ventricular ejection fraction (LVEF). We hypothesized that radiofrequency catheter ablation (RFCA) could improve outcomes in HF patients with AF and impaired left ventricular systolic function (LVEF <50%) as compared with only medical therapy. METHODS: We searched the literature for randomized clinical trials (RCTs) that compared RFCA to medical therapy in this population. RESULTS: Compared with the medical therapy group, the RFCA group had significantly less all-cause mortality, HF hospitalization, and AF recurrence rates. The RFCA group had significantly higher peak oxygen consumption (VO 2max ), a better quality of life (Minnesota Living with Heart Failure Questionnaire score), and improved LVEF. However, RFCA for AF failed to reduce all-cause mortality in a specific meta-analysis of four RCTs that enrolled patients with LVEF ≤35%. CONCLUSION: Compared with medical therapy, RFCA for AF in the setting of HF with impaired systolic function is associated with better clinical (HF hospitalization and all-cause mortality), structural (LVEF improvement), functional (VO 2max ), and quality of life outcomes. However, RFCA for AF failed to reduce all-cause mortality in RCTs that enrolled patients with LVEF ≤35% and thereby indicated the necessary stratification to identify patients who may benefit more from RFCA.
Chang et al. (Thu,) conducted a meta-analysis in Heart failure with atrial fibrillation and impaired systolic function. Radiofrequency catheter ablation vs. Medical therapy was evaluated on All-cause mortality, HF hospitalization, and AF recurrence rates. Radiofrequency catheter ablation significantly reduced all-cause mortality and HF hospitalization compared to medical therapy in patients with AF and LVEF <50%, but not in those with LVEF ≤35%.