Catheter Ablation Superior to Drug Therapy for Atrial Fibrillation in Heart Failure

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Catheter ablation is superior to drug therapy in improving all-cause mortality, LVEF, 6-minute walk test distance, VO2max, and quality of life in patients with heart failure.
Catheter ablation is superior to drug therapy in improving all-cause mortality, LVEF, 6-minute walk test distance, VO2max, and quality of life in patients with heart failure.

Catheter ablation for atrial fibrillation is superior to drug therapy in improving quality of life, all-cause mortality, heart failure hospitalizations, left ventricular (LV) ejection fraction, peak oxygen consumption (VO2max), and 6-minute walk test distance, in patients with heart failure, according to a study published in Annals of Internal Medicine.

This meta-analysis found data from randomized controlled trials published in English through searches of ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, EBSCO Information Services, Google Scholar, PubMed, Web of Science (Clarivate Analytics), and scientific conference sessions between January 1, 2005 and October 1, 2018. To be included, all trials needed to compare clinical outcomes of drug therapy and catheter ablation in adult patients with atrial fibrillation and heart failure with reduced ejection fraction, with at least 6 months follow-up.

Two investigators worked independently to extract data and assess the quality of evidence.

A total of 6 randomized controlled trials with 775 participants were included in the analysis. Catheter ablation showed better outcomes than drug therapy for heart failure hospitalizations (16.4% vs 27.6%; risk ratio [RR], 0.60 [95% CI, 0.39-0.93]) and all-cause mortality (9.0% vs 17.6%; RR, 0.52 [95% CI, 0.33-0.81).

Ablation was also found to improve quality of life (Minnesota Living with Heart Failure Questionnaire score, mean difference, 9.02 [95% CI,  19.75-1.71 points]), LV ejection fraction (mean difference, 6.95% [95% CI, 3.0%-10.9%]), VO2max (mean difference, 3.17 mL/kg per minute [95% CI, 1.26-5.07 mL/kg per minute]), and distance in 6-minute walk test (mean difference, 20.93 m [95% CI, 5.91-35.95 m]).

The rates of serious adverse events were higher for ablation groups compared with drug therapy groups, but these differences were not statistically significant, and were predominantly driven by a single clinical trial (7.2% vs 3.8%; RR, 1.68 [95% CI, 0.58-4.85]).

Study investigators conclude, “compared with standard drug therapy, catheter ablation of [atrial fibrillation] in patients with [heart failure with reduced ejection fraction] reduces all-cause mortality and HF hospitalization and improves [left ventricular ejection fraction], functional capacity, and quality of life.”

Reference

Turagam MK, Garg J, Whang W, et al. Catheter ablation of atrial fibrillation in patients with heart failure: a meta-analysis of randomized controlled trials [published online December 25, 2018]. Ann Intern Med.  doi: 10.7326/M18-0992

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