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 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

12 Scopus citations

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)
Pages (from-to)19-29
Number of pages11
JournalJournal of Interventional Cardiac Electrophysiology
Volume53
Issue number1
DOIs
StatePublished - Oct 1 2018

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)

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