Catheter ablation for atrial fibrillation in heart failure with reduced ejection fraction patients: A meta-analysis

Background The optimal treatment for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF) remains unsettled. Objectives To assess the efficacy of catheter ablation (CA) and medical therapy compared to medical therapy alone in patients with AF and HFrEF. Methods We performed a systematic review of randomized controlled trials (RCTs) comparing CA versus guideline-directed medical therapy for AF in patients with HFrEF (left ventricular ejection fraction (LVEF) ≤40%). We systematically searched PubMed, Embase, and Cochrane for eligible trials. A random-effects model was used to calculate the risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). Results Six RCTs comprising 1,055 patients were included, of whom 530 (50.2%) were randomized to CA. Compared with medical therapy, CA was associated with a significant reduction in heart failure (HF) hospitalization (RR 0.57; 95% CI 0.45-0.72; p<0.01), cardiovascular mortality (RR 0.46; 95% CI 0.31-0.70; p<0.01), all-cause mortality (RR 0.53; 95% CI 0.36-0.78; p<0.01), and AF burden (MD –29.8%; 95% CI –43.73,–15.90; p<0.01). Also, there was a significant improvement in LVEF (MD 3.8%; 95% CI 1.6,6.0; p<0.01) and quality of life (Minnesota living with HF questionnaire; MD –4.92 points; 95% CI –8.61,–1.22; p<0.01) in the ablation group. Conclusion In this meta-analysis of RCTs of patients with AF and HFrEF, CA was associated with a reduction in HF hospitalization and cardiovascular and all-cause mortality, as well as a significant improvement of LVEF and quality of life.