Aiman Smer1, Mohsin Salih2, Yousef H Darrat3, Abdulghani Saadi1, Raviteja Guddeti1, Toufik Mahfood Haddad1, Amjad Kabach1, Mohamed Ayan4, Alok Saurav5, Hussam Abuissa1, Claude S Elayi3. 1. Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska. 2. Department of Internal Medicine, University of Kentucky, Lexington, Kentucky. 3. Department of Cardiovascular Medicine, Gill Heart Institute and VAMC, University of Kentucky, Lexington, Kentucky. 4. Department of Cardiovascular Medicine, Little Rock, Arkansas. 5. Department of Cardiology, Stanford Health, Fargo, North Dakota.
Abstract
BACKGROUND: The role of catheter ablation (CA) is increasingly recognized as a reasonable therapeutic option in patients with atrial fibrillation (AF) and heart failure (HF). HYPOTHESIS: We aimed to compare CA to medical therapy in AF patients with HF with reduced ejection fraction (HFrEF). METHODS: We searched the literature for randomized clinical trials comparing CA to medical therapy in this population. RESULTS: Six trials with a total of 775 patients were included. AF was persistent in 95% of patients with a mean duration of 18.5 ± 23 months prior enrollment. The mean age was 62.2 ± 7.8 years, mostly males (83%) with mean left ventricular ejection fraction (LVEF) of 31.2 ± 6.7%. Compared to medical therapy, CA has significantly improved LVEF by 5.9% (Mean difference [MD] 5.93, confidence interval [CI] 3.59-8.27, P < 0.00001, I2 = 87%), quality of life, (MD -9.01, CI -15.56, -2.45, P = 0.007, I2 = 47%), and functional capacity (MD 25.82, CI 5.46-46.18, P = 0.01, I2 = 90%). CA has less HF hospital readmissions (odds ratio [OR] 0.5, CI 0.32-0.78, P = 0.002, I2 = 0%) and death from any cause (OR 0.46, CI 0.29-0.73, P = 0.0009, I2 = 0%). Freedom from AF during follow-up was higher in patients who had CA (OR 24.2, CI 6.94-84.41, P < 0.00001, I2 = 81%. CONCLUSION: CA was superior to medical therapy in patients with AF and HFrEF in terms of symptoms, hemodynamic response, and clinical outcomes by reducing AF burden. However, these findings are applicable to the very specific patients enrolled in these trials.
BACKGROUND: The role of catheter ablation (CA) is increasingly recognized as a reasonable therapeutic option in patients with atrial fibrillation (AF) and heart failure (HF). HYPOTHESIS: We aimed to compare CA to medical therapy in AFpatients with HF with reduced ejection fraction (HFrEF). METHODS: We searched the literature for randomized clinical trials comparing CA to medical therapy in this population. RESULTS: Six trials with a total of 775 patients were included. AF was persistent in 95% of patients with a mean duration of 18.5 ± 23 months prior enrollment. The mean age was 62.2 ± 7.8 years, mostly males (83%) with mean left ventricular ejection fraction (LVEF) of 31.2 ± 6.7%. Compared to medical therapy, CA has significantly improved LVEF by 5.9% (Mean difference [MD] 5.93, confidence interval [CI] 3.59-8.27, P < 0.00001, I2 = 87%), quality of life, (MD -9.01, CI -15.56, -2.45, P = 0.007, I2 = 47%), and functional capacity (MD 25.82, CI 5.46-46.18, P = 0.01, I2 = 90%). CA has less HF hospital readmissions (odds ratio [OR] 0.5, CI 0.32-0.78, P = 0.002, I2 = 0%) and death from any cause (OR 0.46, CI 0.29-0.73, P = 0.0009, I2 = 0%). Freedom from AF during follow-up was higher in patients who had CA (OR 24.2, CI 6.94-84.41, P < 0.00001, I2 = 81%. CONCLUSION: CA was superior to medical therapy in patients with AF and HFrEF in terms of symptoms, hemodynamic response, and clinical outcomes by reducing AF burden. However, these findings are applicable to the very specific patients enrolled in these trials.
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Authors: Mohammed N Khan; Pierre Jaïs; Jennifer Cummings; Luigi Di Biase; Prashanthan Sanders; David O Martin; Josef Kautzner; Steven Hao; Sakis Themistoclakis; Raffaele Fanelli; Domenico Potenza; Raimondo Massaro; Oussama Wazni; Robert Schweikert; Walid Saliba; Paul Wang; Amin Al-Ahmad; Salwa Beheiry; Pietro Santarelli; Randall C Starling; Antonio Dello Russo; Gemma Pelargonio; Johannes Brachmann; Volker Schibgilla; Aldo Bonso; Michela Casella; Antonio Raviele; Michel Haïssaguerre; Andrea Natale Journal: N Engl J Med Date: 2008-10-23 Impact factor: 91.245