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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
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Atrial Fibrillation Ablation in Heart Failure With Reduced vs Preserved Ejection Fraction: A Systematic Review and
Alireza Oraii1, William F McIntyre1,2, Ratika Parkash3
1Population Health Research Institute, Hamilton, Ontario, Canada.
JAMA Cardiology
|April 24, 2024
Summary
Catheter ablation for atrial fibrillation (AF) significantly reduces heart failure (HF) events in patients with heart failure with reduced ejection fraction (HFrEF). However, it shows no significant benefit for patients with heart failure with preserved ejection fraction (HFpEF).
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Catheter ablation for atrial fibrillation (AF) is established to reduce heart failure (HF) hospitalization and mortality in patients with heart failure with reduced ejection fraction (HFrEF).
- The efficacy of catheter ablation in patients with heart failure with preserved ejection fraction (HFpEF) remains uncertain, necessitating further investigation into HF-related outcomes based on HF phenotype.
Purpose of the Study:
- To evaluate the association between catheter ablation for AF and HF-related outcomes, specifically examining differences between HFrEF and HFpEF phenotypes.
- To determine if catheter ablation offers benefits beyond conventional rate or rhythm control in patients with AF and HF.
Main Methods:
- A systematic literature search was conducted across MEDLINE, Embase, and Cochrane Central databases up to September 2023.
- Included were parallel-group randomized clinical trials (RCTs) comparing catheter ablation to conventional therapy in HF patients (NYHA class II or greater) with AF. Data were extracted and synthesized using random-effects models, with interaction P values used for subgroup analyses.
Main Results:
- Twelve RCTs comprising 2465 participants (1552 with HFrEF, 913 with HFpEF) were analyzed.
- Catheter ablation significantly reduced HF events in HFrEF (RR, 0.59; 95% CI, 0.48-0.72) but not in HFpEF (RR, 0.93; 95% CI, 0.65-1.32; P interaction=0.03).
- Similar trends were observed for cardiovascular and all-cause mortality, with significant reductions in HFrEF but not HFpEF.
Conclusions:
- Catheter ablation for AF is associated with a reduced risk of HF events in patients with HFrEF.
- The study found limited or no benefit of catheter ablation for AF in patients with HFpEF.
- Ongoing trials are expected to provide further insights into the role of catheter ablation in managing AF in the context of HFpEF.
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