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Published on: May 26, 2015
Catheter ablation for atrial fibrillation and impact on clinical outcomes
Rui Providencia1,2, Hussam Ali3, Antonio Creta1,2
1Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, UK.
Insights
Catheter ablation significantly reduces hospitalizations and mortality in atrial fibrillation (AF) patients. This rhythm control strategy improves hard clinical outcomes, especially in those with heart failure (HF).
Area of Science:
- Cardiology
- Electrophysiology
- Clinical Trials
Background:
- Catheter ablation is an effective rhythm-control treatment for atrial fibrillation (AF), primarily used for symptom management.
- The impact of catheter ablation on major adverse clinical outcomes in AF patients requires further investigation.
Purpose of the Study:
- To assess the effect of catheter ablation on hard clinical outcomes in patients with atrial fibrillation (AF).
- To compare catheter ablation against optimized medical treatment using a systematic review of randomized controlled trials (RCTs).
Main Methods:
- Systematic review of RCTs comparing catheter ablation with optimized medical treatment, searching MEDLINE, EMBASE, and CENTRAL up to January 8, 2024.
- Data synthesis using risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI); calculation of the number needed to treat (NNT).
- Subgroup and sensitivity analyses were conducted based on heart failure (HF) status, AF type, ablation timing, and study quality/publication date.
Main Results:
- Catheter ablation significantly reduced all-cause hospitalization (RR=0.57), AF relapse (RR=0.48), and all-cause mortality (RR=0.69) compared to medical management.
- Significant benefits were observed for cardiovascular mortality (RR=0.55), cardiovascular hospitalizations (RR=0.83), and HF hospitalizations (RR=0.71).
- Improvements were noted in AF burden (MD=20.6%), left ventricular ejection fraction (LVEF) recovery (MD=5.7%), and quality of life scores.
Conclusions:
- Catheter ablation is superior to optimized medical treatment in reducing hospitalizations, AF burden, and relapse, while improving quality of life.
- Catheter ablation demonstrates a significant impact on hard clinical outcomes, including mortality reduction and LVEF improvement, particularly in AF patients with heart failure.
Aims:
Catheter ablation is the most effective rhythm-control option in patients with atrial fibrillation (AF) and is currently considered an option mainly for improving symptoms. We aimed to assess the impact of catheter ablation on hard clinical outcomes.
Methods And Results:
We performed a systematic review of randomized controlled trials (RCTs) comparing catheter ablation vs. optimized medical treatment. We searched MEDLINE, EMBASE, and CENTRAL on 8 January 2024, for trials published ≤10 years. We pooled data through risk ratio (RR) and mean differences (MDs), with 95% confidence interval (CI), and calculated the number needed to treat (NNT). Sub-group and sensitivity analyses were performed for the presence/absence of heart failure (HF), paroxysmal/persistent AF, early ablation, higher/lower quality, and published ≤5 vs. >5 years. Twenty-two RCTs were identified, including 6400 patients followed for 6-52 months. All primary endpoints were significantly reduced by catheter ablation vs. medical management: all-cause hospitalization (RR = 0.57, 95% CI 0.39-0.85, P = 0.006), AF relapse (RR = 0.48, 95% CI 0.39-0.58, P < 0.00001), and all-cause mortality (RR = 0.69, 95% CI 0.56-0.86, P = 0.0007, NNT = 44.7, driven by trials with HF patients). A benefit was also demonstrated for all secondary endpoints: cardiovascular mortality (RR = 0.55, 95% CI 0.34-0.87), cardiovascular (RR = 0.83, 95% CI 0.71-0.96), and HF hospitalizations (RR = 0.71, 95% CI 0.56-0.89), AF burden (MD = 20.6%, 95% CI 5.6-35.5), left ventricular ejection fraction (LVEF) recovery (MD = 5.7%, 95% CI 3.5-7.9), and quality of life (MLHFQ, AFEQT, and SF-36 scales).
Conclusion:
Catheter ablation significantly reduced hospitalizations, AF burden, and relapse, and improved quality of life. An impact on hard clinical outcomes, with an important mortality reduction and improvement in LVEF, was seen for patients with AF and HF.
