Rhythm Control of Persistent Atrial Fibrillation in Systolic Heart Failure: A Bayesian Network Meta-Analysis of...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Interventions

Background:

• Persistent atrial fibrillation (PeAF) with heart failure (HF) represents a high-risk patient group.
• Understanding optimal treatment strategies for this population is crucial.

Purpose of the Study:

• To compare the effectiveness of catheter ablation (CA) of AF, rate-controlling drugs (RCDs), anti-arrhythmic drugs (AADs), and atrio-ventricular nodal ablation (AVNA) in PeAF patients with systolic HF.
• To evaluate outcomes including all-cause mortality, heart failure-related quality of life (QoL), and heart failure hospitalizations (HHF).

Main Methods:

• A systematic literature search was conducted across PubMed, Embase, and Scopus databases.
• A Bayesian network meta-analysis (NMA) was performed to compare the specified treatment strategies.
• Outcomes analyzed included all-cause mortality, QoL changes, and HHF.

Main Results:

• Ablation strategies significantly reduced mortality and HHF compared to medical therapies.
• Catheter ablation (CA) of AF demonstrated a trend towards lower mortality and was superior to AAD and AVNA in reducing HHF.
• Rhythm control strategies, particularly CA, significantly improved QoL compared to rate control strategies.

Conclusions:

• Catheter ablation (CA) of AF is the most effective strategy for managing PeAF patients with systolic HF.
• CA improves all-cause mortality, HF-related QoL, and reduces HHF in this complex patient cohort.