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Updated: Jun 27, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Catheter ablation for atrial fibrillation in heart failure with reduced ejection fraction patients: A meta-analysis
Eric Pasqualotto1, Caique M P Ternes2, Matheus Pedrotti Chavez1
1Division of Medicine, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
Insights
Catheter ablation significantly reduces heart failure hospitalizations and mortality in patients with atrial fibrillation and heart failure with reduced ejection fraction. This effective treatment also improves ejection fraction and quality of life.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Optimal treatment for atrial fibrillation (AF) in heart failure with reduced ejection fraction (HFrEF) is not well-established.
- Existing therapies present challenges in managing these complex patient populations.
Purpose of the Study:
- To evaluate the efficacy of catheter ablation (CA) plus medical therapy versus medical therapy alone for patients with AF and HFrEF.
- To compare clinical outcomes and quality of life between the two treatment strategies.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Included studies compared CA with guideline-directed medical therapy in patients with LVEF ≤ 40%.
- Searched PubMed, Embase, and Cochrane databases; employed random effects models for analysis.
Main Results:
- Six RCTs with 1055 patients were analyzed; 50.2% received CA.
- CA significantly reduced heart failure hospitalizations (RR 0.57), cardiovascular mortality (RR 0.46), and all-cause mortality (RR 0.53).
- Improvements observed in LVEF (MD 3.8%) and quality of life (MD -4.92 points) with CA.
Conclusions:
- Catheter ablation is associated with reduced mortality and hospitalizations in AF patients with HFrEF.
- CA significantly improves left ventricular ejection fraction and quality of life in this patient group.
- Findings support CA as a valuable therapeutic option for selected patients with AF and HFrEF.
Background:
The optimal treatment of atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF) remains unsettled.
Objective:
The purpose of this study was to assess the efficacy of catheter ablation (CA) and medical therapy compared to medical therapy alone in patients with AF and HFrEF.
Methods:
We performed a systematic review of randomized controlled trials (RCTs) comparing CA with guideline-directed medical therapy for AF in patients with HFrEF (left ventricular ejection fraction [LVEF] ≤ 40%). We systematically searched PubMed, Embase, and Cochrane for eligible trials. A random effects model was used to calculate the risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs).
Results:
Six RCTs comprising 1055 patients were included, of whom 530 (50.2%) were randomized to CA. Compared with medical therapy, CA was associated with a significant reduction in heart failure (HF) hospitalization (RR 0.57; 95% CI 0.45-0.72; P < .01), cardiovascular mortality (RR 0.46; 95% CI 0.31-0.70; P < .01), all-cause mortality (RR 0.53; 95% CI 0.36-0.78; P < .01), and AF burden (MD -29.8%; 95% CI -43.73% to -15.90%; P < .01). Also, there was a significant improvement in LVEF (MD 3.8%; 95% CI 1.6%-6.0%; P < .01) and quality of life (Minnesota Living with Heart Failure Questionnaire; MD -4.92 points; 95% CI -8.61 to -1.22 points; P < .01) in the ablation group.
Conclusion:
In this meta-analysis of RCTs of patients with AF and HFrEF, CA was associated with a reduction in HF hospitalization, cardiovascular mortality, and all-cause mortality as well as a significant improvement in LVEF and quality of life.
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