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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

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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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Funding

This research did not receive any funding.

Author information

Authors and Affiliations

  1. Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    David F. Briceño, Timothy M. Markman, Jackson J. Liang, Fermin C. Garcia, Francis E. Marchlinski & Pasquale Santangeli

  2. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA

    Florentino Lupercio, Jorge Romero & Luigi Di Biase

  3. Division of Cardiology, New York University Langone Medical Center, New York, NY, USA

    Pedro A. Villablanca

  4. Heart Failure Section, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Edo Y. Birati

  5. Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA

    Luigi Di Biase & Andrea Natale

  6. Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Pasquale Santangeli

Authors
  1. David F. Briceño
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  2. Timothy M. Markman
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  9. Luigi Di Biase
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Corresponding author

Correspondence to Pasquale Santangeli.

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Conflict of interest

Dr. Di Biase is a consultant for Biosense Webster, Boston Scientific, and St. Jude Medical and has received speaker honoraria/travel from Medtronic, Atricure, EPiEP, and Biotronik. Dr. Natale is a consultant for Biosense Webster, Stereotaxis, and St Jude Medical. Natale received speaker honoraria/travel from Medtronic, Atricure, EPiEP Biotronik, and Janssen. Dr. Marchlinski is a consultant for Abbot/St Jude Medical; Biotronik; Biosense Webster, Inc.; Infobionics; Medtronic, Inc.; and Boston Scientific Corp. and receives research grant from Biosense Webster, Inc. and fellowship support from Abbot/St Jude Medical; Biotronik; Biosense Webster, Inc.; Medtronic, Inc.; and Boston Scientific Corp. The remaining authors have no disclosures.

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Briceño, D.F., Markman, T.M., Lupercio, F. et al. 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. J Interv Card Electrophysiol 53, 19–29 (2018). https://doi.org/10.1007/s10840-018-0425-0

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