Open AccessThe impact of catheter ablation for atrial fibrillation in heart failure
Author(s) -
Moschonas Konstantinos,
Nabeebaccus Adam,
Okonko Darlington O.,
McDonagh Theresa A.,
Murgatroyd Francis D.,
Dhillon Para,
Scott Paul A.
Publication year - 2019
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1002/joa3.12115
Subject(s) - medicine , atrial fibrillation , ablation , ejection fraction , cardiology , heart failure , catheter ablation , pulmonary vein , randomized controlled trial , relative risk , confidence interval
Atrial fibrillation ( AF ) commonly co‐exists with systolic heart failure ( SHF ) and its presence is associated with a worse prognosis. Despite this, a rhythm control approach using antiarrhythmic drugs ( AAD s) to reduce AF burden has demonstrated no prognostic benefit. Catheter ablation ( AFA ) is more effective than AAD s at reducing AF burden. We performed a meta‐analysis to evaluate the impact of AFA on outcomes in SHF . Electronic databases were systematically searched. We included only randomized controlled trials that examined the impact of AFA on clinical outcomes in patients with SHF ( LVEF <50%). We included studies with any ablation strategy that incorporated pulmonary vein isolation and any control group. Seven studies (n = 858) were included with a mean follow‐up of 6‐38 months. In comparison to controls, AFA was associated with significant reductions in all‐cause mortality (relative risk [ RR ] 0.52, P = 0.0009) and unplanned or heart failure hospitalization ( RR 0.58, P < 0.00001). Compared to controls, AFA was also associated with significant improvements in LVEF (mean difference 6.30%, P < 0.00001), Minnesota Living with Heart Failure Questionnaire score (mean difference 9.58, P = 0.0003), 6‐minute walk distance (mean difference 31.78 m, P = 0.003) and VO 2 max (mean difference 3.17, P = 0.003). However, major procedure‐related complications occurred in 2.4%‐15% of ablation patients. In patients with AF and SHF , catheter ablation has significant benefits. Further work is needed to establish the role of ablation in the routine treatment of SHF patients with AF .