Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes
D-PO03 - Poster Session III (ID 48)
Poster
D-PO03-201 - Improved Survival In Patients With Atrial Fibrillation And Heart Failure With Reduced Ejection Fraction Undergoing Catheter Ablation Compared To Medical Treatment: A Meta-analysis Of Randomized Controlled Trials (ID 1156)
Authors
- Isabella Alviz
- Luigi Di Biase
- David F. Briceno
- Kavisha Patel
- Juan C. Diaz
- Mohamed Gabr
- Saul Rios
- Alejandro Velasco
- Chintan G. Trivedi
- Sanghamitra Mohanty
- Nicola Tarantino
- Xiao-Dong Zhang
- Olga Reynbakh
- Rakesh Gopinathannair
- Keke Young
- Domenico G. Della Rocca
- J. David Burkhardt
- Amin Al-Ahmad
- G. Joseph Gallinghouse
- Dhanunjaya R. Lakkireddy
- Andrea Natale
- Jorge Romero
Abstract
Background: Increasing evidence from randomized controlled trials (RCTs) has suggested improved outcomes in patients with heart failure undergoing catheter ablation (CA) for atrial fibrillation (AF) compared to medical therapy.
Objective: To evaluate whether CA for AF in patients with heart failure with reduced ejection fraction (HFrEF) decreases all-cause mortality compared to medical therapy.
Methods: Electronic databases were analyzed for RCTs comparing CA with medical therapy in adults with AF and HFrEF. The primary endpoint was all-cause mortality. Secondary endpoint was change in left ventricular ejection fraction (LVEF). Risk ratio (RR), standard mean difference (SMD), and 95% confidence intervals (CI) were measured. A fixed effect model was used for all-cause mortality given the I2< 25%, while random-effect model was used for change in LVEF with I2>25%.
Results: Six RCTs were included with a total of 1,203 patients (mean age: 62.8 years; male 82.5%). The mean follow-up was 30 ±23 months. All-cause mortality in patients who underwent CA was 10.24% vs. 17% in those who received medical treatment (RR 0.61, 95% CI 0.45-0.81, p=0.0007). Improvement in the LVEF was significantly higher in patients undergoing CA (+8±10%)compared to conventional treatment (+3±11%)(SMD 0.48, 95% CI 0.24-0.71, p<0.0001).
Conclusion: CA for AF in patients with HFrEF decreases mortality and improves LVEF when compared to medical management. CA should be considered the treatment of choice to improve survival in this selected group of patients.
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Objective: To evaluate whether CA for AF in patients with heart failure with reduced ejection fraction (HFrEF) decreases all-cause mortality compared to medical therapy.
Methods: Electronic databases were analyzed for RCTs comparing CA with medical therapy in adults with AF and HFrEF. The primary endpoint was all-cause mortality. Secondary endpoint was change in left ventricular ejection fraction (LVEF). Risk ratio (RR), standard mean difference (SMD), and 95% confidence intervals (CI) were measured. A fixed effect model was used for all-cause mortality given the I2< 25%, while random-effect model was used for change in LVEF with I2>25%.
Results: Six RCTs were included with a total of 1,203 patients (mean age: 62.8 years; male 82.5%). The mean follow-up was 30 ±23 months. All-cause mortality in patients who underwent CA was 10.24% vs. 17% in those who received medical treatment (RR 0.61, 95% CI 0.45-0.81, p=0.0007). Improvement in the LVEF was significantly higher in patients undergoing CA (+8±10%)compared to conventional treatment (+3±11%)(SMD 0.48, 95% CI 0.24-0.71, p<0.0001).
Conclusion: CA for AF in patients with HFrEF decreases mortality and improves LVEF when compared to medical management. CA should be considered the treatment of choice to improve survival in this selected group of patients.
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