Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials

David F. Briceño, Timothy M. Markman, Florentino Lupercio, Jorge E. Romero, Jackson J. Liang, Pedro A. Villablanca, Edo Y. Birati, Fermin C. Garcia, Luigi Di Biase, Andrea Natale, Francis E. Marchlinski, Pasquale Santangeli

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Purpose: To evaluate whether catheter ablation is superior to conventional therapy for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). Methods: Electronic databases were searched for randomized, controlled trials of AF ablation compared with conventional therapy in adults with AF and HFrEF. Odds ratio (OR), standard mean difference (SMD), and 95% confidence intervals (CIs) were measured using the Mantel-Haenszel method. Results: There were seven trials including 856 patients (mean age 62 years, male 86%). All-cause mortality in patients who underwent ablation was 10% vs. 19% in those who received conventional treatment (four trials, 668 patients, 47% relative reduction, 9% absolute reduction; OR 0.46, 95% CI 0.29–0.72). Improvement in the left ventricular ejection fraction was significantly higher for patients undergoing ablation (+ 9 ± 10%) compared to conventional treatment (+ 2 ± 7%) (seven trials, 856 patients, SMD 0.68, 95% CI 0.28–1.08). Freedom from AF was higher in patients undergoing ablation (seven trials, 856 patients, 70% vs. 18%, respectively; 64% relative reduction, 52% absolute reduction; OR 0.03 95% CI 0.01–0.11). There was no significant difference in major complications between both strategies (OR 1.13, 95% CI 0.58–2.20). Conclusions: Catheter ablation for AF in patients with HFrEF decreases mortality and AF recurrence and improves left ventricular function, functional capacity, and quality of life, when compared to conventional management, without increasing complications.

Original languageEnglish (US)
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2018

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Catheter Ablation
Atrial Fibrillation
Meta-Analysis
Randomized Controlled Trials
Heart Failure
Confidence Intervals
Odds Ratio
Therapeutics
Mortality
Left Ventricular Function
Stroke Volume
Quality of Life
Databases
Recurrence

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Heart failure with reduced ejection fraction
  • Meta-analysis
  • Randomized controlled trial
  • Systolic heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction : a systematic review and meta-analysis of randomized controlled trials. / Briceño, David F.; Markman, Timothy M.; Lupercio, Florentino; Romero, Jorge E.; Liang, Jackson J.; Villablanca, Pedro A.; Birati, Edo Y.; Garcia, Fermin C.; Di Biase, Luigi; Natale, Andrea; Marchlinski, Francis E.; Santangeli, Pasquale.

In: Journal of Interventional Cardiac Electrophysiology, 01.01.2018.

Research output: Contribution to journalArticle

Briceño, David F. ; Markman, Timothy M. ; Lupercio, Florentino ; Romero, Jorge E. ; Liang, Jackson J. ; Villablanca, Pedro A. ; Birati, Edo Y. ; Garcia, Fermin C. ; Di Biase, Luigi ; Natale, Andrea ; Marchlinski, Francis E. ; Santangeli, Pasquale. / Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction : a systematic review and meta-analysis of randomized controlled trials. In: Journal of Interventional Cardiac Electrophysiology. 2018.
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abstract = "Purpose: To evaluate whether catheter ablation is superior to conventional therapy for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). Methods: Electronic databases were searched for randomized, controlled trials of AF ablation compared with conventional therapy in adults with AF and HFrEF. Odds ratio (OR), standard mean difference (SMD), and 95{\%} confidence intervals (CIs) were measured using the Mantel-Haenszel method. Results: There were seven trials including 856 patients (mean age 62 years, male 86{\%}). All-cause mortality in patients who underwent ablation was 10{\%} vs. 19{\%} in those who received conventional treatment (four trials, 668 patients, 47{\%} relative reduction, 9{\%} absolute reduction; OR 0.46, 95{\%} CI 0.29–0.72). Improvement in the left ventricular ejection fraction was significantly higher for patients undergoing ablation (+ 9 ± 10{\%}) compared to conventional treatment (+ 2 ± 7{\%}) (seven trials, 856 patients, SMD 0.68, 95{\%} CI 0.28–1.08). Freedom from AF was higher in patients undergoing ablation (seven trials, 856 patients, 70{\%} vs. 18{\%}, respectively; 64{\%} relative reduction, 52{\%} absolute reduction; OR 0.03 95{\%} CI 0.01–0.11). There was no significant difference in major complications between both strategies (OR 1.13, 95{\%} CI 0.58–2.20). Conclusions: Catheter ablation for AF in patients with HFrEF decreases mortality and AF recurrence and improves left ventricular function, functional capacity, and quality of life, when compared to conventional management, without increasing complications.",
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T1 - Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction

T2 - a systematic review and meta-analysis of randomized controlled trials

AU - Briceño, David F.

AU - Markman, Timothy M.

AU - Lupercio, Florentino

AU - Romero, Jorge E.

AU - Liang, Jackson J.

AU - Villablanca, Pedro A.

AU - Birati, Edo Y.

AU - Garcia, Fermin C.

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Marchlinski, Francis E.

AU - Santangeli, Pasquale

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: To evaluate whether catheter ablation is superior to conventional therapy for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). Methods: Electronic databases were searched for randomized, controlled trials of AF ablation compared with conventional therapy in adults with AF and HFrEF. Odds ratio (OR), standard mean difference (SMD), and 95% confidence intervals (CIs) were measured using the Mantel-Haenszel method. Results: There were seven trials including 856 patients (mean age 62 years, male 86%). All-cause mortality in patients who underwent ablation was 10% vs. 19% in those who received conventional treatment (four trials, 668 patients, 47% relative reduction, 9% absolute reduction; OR 0.46, 95% CI 0.29–0.72). Improvement in the left ventricular ejection fraction was significantly higher for patients undergoing ablation (+ 9 ± 10%) compared to conventional treatment (+ 2 ± 7%) (seven trials, 856 patients, SMD 0.68, 95% CI 0.28–1.08). Freedom from AF was higher in patients undergoing ablation (seven trials, 856 patients, 70% vs. 18%, respectively; 64% relative reduction, 52% absolute reduction; OR 0.03 95% CI 0.01–0.11). There was no significant difference in major complications between both strategies (OR 1.13, 95% CI 0.58–2.20). Conclusions: Catheter ablation for AF in patients with HFrEF decreases mortality and AF recurrence and improves left ventricular function, functional capacity, and quality of life, when compared to conventional management, without increasing complications.

AB - Purpose: To evaluate whether catheter ablation is superior to conventional therapy for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). Methods: Electronic databases were searched for randomized, controlled trials of AF ablation compared with conventional therapy in adults with AF and HFrEF. Odds ratio (OR), standard mean difference (SMD), and 95% confidence intervals (CIs) were measured using the Mantel-Haenszel method. Results: There were seven trials including 856 patients (mean age 62 years, male 86%). All-cause mortality in patients who underwent ablation was 10% vs. 19% in those who received conventional treatment (four trials, 668 patients, 47% relative reduction, 9% absolute reduction; OR 0.46, 95% CI 0.29–0.72). Improvement in the left ventricular ejection fraction was significantly higher for patients undergoing ablation (+ 9 ± 10%) compared to conventional treatment (+ 2 ± 7%) (seven trials, 856 patients, SMD 0.68, 95% CI 0.28–1.08). Freedom from AF was higher in patients undergoing ablation (seven trials, 856 patients, 70% vs. 18%, respectively; 64% relative reduction, 52% absolute reduction; OR 0.03 95% CI 0.01–0.11). There was no significant difference in major complications between both strategies (OR 1.13, 95% CI 0.58–2.20). Conclusions: Catheter ablation for AF in patients with HFrEF decreases mortality and AF recurrence and improves left ventricular function, functional capacity, and quality of life, when compared to conventional management, without increasing complications.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Heart failure with reduced ejection fraction

KW - Meta-analysis

KW - Randomized controlled trial

KW - Systolic heart failure

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