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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Comparative Therapeutic Assessment of Atrial Fibrillation in Heart Failure With Reduced Ejection Fraction-A Network

Aaqib H Malik1, Wilbert S Aronow

  • 1Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY.

American Journal of Therapeutics
|January 8, 2019
PubMed

Insights

Catheter ablation (CA) significantly reduces mortality and heart failure hospitalizations in atrial fibrillation (AF) patients with reduced ejection fraction (HFrEF). CA also improves heart function and quality of life, supporting its use as a first-line therapy.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Atrial fibrillation (AF) management in heart failure with reduced ejection fraction (HFrEF) remains challenging.
  • Catheter ablation (CA) is emerging as a potential first-line strategy for these patients.

Purpose of the Study:

  • To compare the effectiveness of CA versus optimal medical treatment and anti-arrhythmic drugs for AF in HFrEF patients.
  • To evaluate CA's impact on mortality, heart failure hospitalizations, and cardiac function.

Main Methods:

  • Network meta-analysis of 17 randomized controlled trials (RCTs) involving 5460 participants.
  • Included treatments: CA, optimal medical therapy, anti-arrhythmic drugs, and placebo.
  • Primary outcomes: all-cause mortality, heart failure hospitalization, and left ventricular ejection fraction (LVEF) change.

Main Results:

  • CA significantly reduced all-cause mortality (OR 0.44) and heart failure hospitalizations (OR 0.41) compared to optimal medical therapy.
  • CA improved LVEF (OR 9.34), quality of life (Minnesota Living with Heart Failure Questionnaire score reduction), and 6-minute walking distance (6MWT).

Conclusions:

  • Catheter ablation is the most effective and safe treatment for AF patients with HFrEF.
  • CA should be considered a first-line therapy for managing AF in this patient population.
Abstract

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