Heart failure

Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction: a meta-analysis

This article was originally published here

Clin Cardiol. 2022 May 11. doi: 10.1002/clc.23841. Online ahead of print.

ABSTRACT

BACKGROUND: Catheter ablation (CA) is an effective treatment for patients with atrial fibrillation (AF). The potential of CA to benefit AF patients with heart failure and preserved ejection fraction (HFpEF) is uncertain.

HYPOTHESIS: CA may be safe and effective for patients with HFpEF.

METHODS: The Medline, PubMed, Embase and Cochrane Library databases were searched for studies evaluating CA for AF patients with HFpEF.

RESULTS: A total of seven trials involving 1696 patients were included. Pooled analyzes demonstrated similar fluoroscopy procedure and time regarding AC use for patients with HFpEF and without IC (weighted mean difference [WMD]: 0.40; 95% confidence interval (CI): -0.01-0.81, p=0.05 and [WMD: 0.05; 95% CI: -0.18-0.28, p = .68]). In addition, AC was effective in maintaining sinus rhythm (SR) in patients with HFpEF and not inferior for patients without HF[relativerisk(RR):092;95%CI:076-110p=034)InadditionACtendedtosignificantlymaintainSR(RR:473;95%CI:186-1203p=0001)andtoreducerehospitalizationsforCIcomparedtomedicaltreatment(RR:036;95%CI:019-071p=003)110p=34)AdditionallyCAtendedtosignificantlymaintainSR(RR:473;95%CI:186-1203p=001)andreducerehospitalizationforHFcomparedwithmedicaltherapy(RR:036;95%CI:019-071p=003)Howevernosignificantdifferenceswerefoundbetweentwogroupsregardingthemortalityrate(p=59)[risquerelatif(RR) :092 ;ICà95 % :076-110p=034)Deplusl’ACavaittendanceàmaintenirsignificativementlaSR(RR :473 ;ICà95 % :186-1203p=0001)etàréduirelesréhospitalisationspourICparrapportautraitementmédical(RR :036 ;ICà95 % :019-071p=003)Cependantaucunedifférencesignificativen’aététrouvéeentrelesdeuxgroupesconcernantletauxdemortalité(p=059)[riskratio(RR):092;95%CI:076-110p=34)AdditionallyCAtendedtosignificantlymaintainSR(RR:473;95%CI:186-1203p=001)andreducerehospitalizationforHFcomparedwithmedicaltherapy(RR:036;95%CI:019-071p=003)Howevernosignificantdifferenceswerefoundbetweentwogroupsregardingthemortalityrate(p=59)

CONCLUSION: AC is a potential treatment strategy for patients with HFpEF and demonstrates equivalent efficacy to patients without IC. Moreover, the benefits of CA in maintaining RS and reducing rehospitalizations for IC patients were significantly better than those of medical treatment. Additional randomized controlled trials are warranted to confirm our findings.

PMID:35544952 | DO I:10.1002/clc.23841