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Efficacy and safety of catheter ablation vs. rate control of atrial fibrillation in systolic left ventricular dysfunction

A meta-analysis and systematic review

Wirksamkeit und Sicherheit der Katheterablation vs. Frequenzkontrolle bei Vorhofflimmern mit systolischer linksventrikulärer Dysfunktion

Metaanalyse und systematische Übersicht

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Abstract

Purpose

It is unclear what constitutes the optimal strategy for management of atrial fibrillation (AF) in patients with systolic left ventricular (LV) dysfunction. We hypothesized that catheter ablation of AF had benefits compared with rate control in patients with systolic LV dysfunction.

Methods

PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials and nonrandomized, observational studies. Weighted mean differences (WMD) and 95 % confidence intervals (CIs) were calculated to compare the improvement of left ventricular ejection fraction (LVEF), functional capacity, and quality of life between a catheter ablation group and a rate control group.

Results

Six trials with 324 patients were included in the analysis. Patients in the catheter ablation group had greater improvement of LVEF (WMD: 8.89; 95 % CI: 6.93–10.86; p < 0.001), 6-min walk distance (WMD: 46.9; 95 % CI: 28.5–65.4; p < 0.001), and lower Minnesota Living With Heart Failure Questionnaire (MLHFQ) scores (WMD: − 19.6; 95 % CI: − 23.6–− 15.7; p < 0.001) compared with patients in the rate control group. Overall, there were only ten procedure-related events and the procedure-related events rate was 4.9 % per procedure and 5.6 % per patient.

Conclusion

The present analysis suggests that catheter ablation of AF has benefits in terms of an improvement in LVEF, in functional capacity, and in quality of life compared with rate control in patients with systolic LV dysfunction, and the risk of complications related to procedures is acceptable.

Zusammenfassung

Ziel

Die optimale Strategie zur Behandlung des Vorhofflimmerns (VF) bei Patienten mit systolischer linksventrikulärer (LV-)Dysfunktion ist noch unklar. Die Autoren stellten die Hypothese auf, dass die Katheterablation bei VF gegenüber der Frequenzkontrolle bei Patienten mit systolischer LV-Dysfunktion Vorteile habe.

Methoden

PUBMED, EMBASE und die Cochrane Library wurden auf randomisierte kontrollierte Studien und nichtrandomisierte Beobachtungsstudien hin durchsucht. Die gewichteten mittleren Differenzen (WMD) und 95 %-Konfidenzintervalle (KI) wurden berechnet, um die Verbesserung der linksventrikulären Ejektionsfraktion (LVEF), der funktionellen Kapazität und der Lebensqualität zwischen der Gruppe mit Katheterablation und der Gruppe mit Frequenzkontrolle zu vergleichen.

Ergebnisse

Sechs Studien mit 324 Patienten wurden in die Auswertung einbezogen. Bei Patienten in der Katheterablationsgruppe zeigten sich eine größere Verbesserung der LVEF (WMD: 8,89; 95 %-KI: 6,93–10,86; p < 0,001), der 6-min-Gehstrecke (WMD: 46,9; 95 %-KI: 28,5–65,4; p < 0,001) und niedrigere Werte im Minnesota Living With Heart Failure Questionnaire (MLHFQ; WMD: − 19,6; 95 %-KI: − 23,6 bis − 15,7; p < 0,001) im Vergleich zu den Patienten in der Frequenzkontrollgruppe. Insgesamt gab es nur 10 eingriffsbedingte Ereignisse, dabei betrug die eingriffsbedingte Ereignisrate 4,9 % pro Eingriff und 5,6 % pro Patient.

Schlussfolgerung

Die vorliegende Auswertung gibt Hinweise darauf, dass die Katheterablation bei VF Vorteile bezüglich der Verbesserung der LVEF, der funktionellen Kapazität und der Lebensqualität gegenüber der Frequenzkontrolle bei Patienten mit systolischer LV-Dysfunktion hat und eine annehmbares eingriffsbedingtes Komplikationsrisiko aufweist.

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Acknowledgments

We thank all of our colleagues working in the Department of Cardiology, the Affiliated People’s Hospital of Jiangsu University.

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Authors and Affiliations

  1. Department of Cardiology, People’s Hospital of Jiangsu University, 8 Dianli Road, 212002, Zhenjiang, Jiangsu, China

    B. Zhang, D. Shen, Y. Zhen & G. Zhang PhD, MD

  2. Department of Nephrology, People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China

    S. Feng

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  1. B. Zhang
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  2. D. Shen
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  3. S. Feng
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  4. Y. Zhen
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Correspondence to G. Zhang PhD, MD.

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Conflict of interest

B, Zhang, D. Shen, S. Feng, Y. Zhen, and G. Zhang state that there are no conflicts of interest.

Additional information

B. Zhang and D. Shen contributed equally to this study.

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Zhang, B., Shen, D., Feng, S. et al. Efficacy and safety of catheter ablation vs. rate control of atrial fibrillation in systolic left ventricular dysfunction. Herz 41, 342–350 (2016). https://doi.org/10.1007/s00059-015-4372-6

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  • DOI: https://doi.org/10.1007/s00059-015-4372-6

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