Catheter ablation for treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction

A systematic review and meta-analysis

Pradyumna Agasthi, Justin Z. Lee, Mustapha Amin, Farah Al-Saffar, Vasudha Goel, Andrew Tseng, Diana Almader-Douglas, Ammar M. Killu, Abhishek J. Deshmukh, Freddy Del-Carpio Munoz, Siva Mulpuru

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Atrial fibrillation (AF) among patients with heart failure with reduced ejection fraction (HFrEF) is associated with adverse clinical outcomes. Our primary aim was to evaluate patient-centered outcomes and surrogate outcomes following catheter ablation (CA) of AF among patients with HFrEF compared to standard medical therapy with or without device therapy (atrioventricular node ablation and cardiac resynchronization therapy). Methods: A systematic literature review was performed limiting our searches to randomized control trials reporting outcomes of CA compared to standard medical therapy with or without device therapy were included. Patient-centered outcomes were relative reduction in all-cause mortality, heart failure readmissions, and recurrence of AF. Surrogate outcomes of interest were change in ejection fraction, change in peak oxygen consumption, reduction in brain natriuretic peptide levels, change in 6-minute walk distance, and change in Minnesota living with heart failure score. Results: Seven randomized control trials (Patient n = 721) met our inclusion criteria. All trials used radiofrequency energy for CA of AF. CA for AF was associated with significantly lower all-cause mortality (Risk ratio [RR] = 0.52, 95% confidence interval [CI] = 0.35-0.76, P = 0.001, I2 = 0%), lower rate of heart failure readmission (RR = 0.58, 95% CI = 0.46-0.74, P < 0.001, I2 = 0%) and lower rate of AF recurrence (RR = 0.33, 95% CI = 0.22-0.50, P < 0.001, I2 = 68%) as compared to standard medical therapy. Surrogate outcomes showed a similar benefit favoring CA. Conclusion and Relevance: Catheter ablation for AF in HFrEF is associated with improvement in patient-centered outcomes and surrogate outcomes when compared to standard medical therapy with or without device therapy.

Original languageEnglish (US)
JournalJournal of Arrhythmia
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Catheter Ablation
Atrial Fibrillation
Meta-Analysis
Heart Failure
Odds Ratio
Confidence Intervals
Equipment and Supplies
Therapeutics
Recurrence
Atrioventricular Node
Cardiac Resynchronization Therapy
Mortality
Brain Natriuretic Peptide
Oxygen Consumption

Keywords

  • atrial fibrillation
  • catheter ablation
  • hospital readmission
  • mortality
  • systolic heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Catheter ablation for treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction : A systematic review and meta-analysis. / Agasthi, Pradyumna; Lee, Justin Z.; Amin, Mustapha; Al-Saffar, Farah; Goel, Vasudha; Tseng, Andrew; Almader-Douglas, Diana; Killu, Ammar M.; Deshmukh, Abhishek J.; Del-Carpio Munoz, Freddy; Mulpuru, Siva.

In: Journal of Arrhythmia, 01.01.2019.

Research output: Contribution to journalArticle

Agasthi, Pradyumna ; Lee, Justin Z. ; Amin, Mustapha ; Al-Saffar, Farah ; Goel, Vasudha ; Tseng, Andrew ; Almader-Douglas, Diana ; Killu, Ammar M. ; Deshmukh, Abhishek J. ; Del-Carpio Munoz, Freddy ; Mulpuru, Siva. / Catheter ablation for treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction : A systematic review and meta-analysis. In: Journal of Arrhythmia. 2019.
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abstract = "Background: Atrial fibrillation (AF) among patients with heart failure with reduced ejection fraction (HFrEF) is associated with adverse clinical outcomes. Our primary aim was to evaluate patient-centered outcomes and surrogate outcomes following catheter ablation (CA) of AF among patients with HFrEF compared to standard medical therapy with or without device therapy (atrioventricular node ablation and cardiac resynchronization therapy). Methods: A systematic literature review was performed limiting our searches to randomized control trials reporting outcomes of CA compared to standard medical therapy with or without device therapy were included. Patient-centered outcomes were relative reduction in all-cause mortality, heart failure readmissions, and recurrence of AF. Surrogate outcomes of interest were change in ejection fraction, change in peak oxygen consumption, reduction in brain natriuretic peptide levels, change in 6-minute walk distance, and change in Minnesota living with heart failure score. Results: Seven randomized control trials (Patient n = 721) met our inclusion criteria. All trials used radiofrequency energy for CA of AF. CA for AF was associated with significantly lower all-cause mortality (Risk ratio [RR] = 0.52, 95{\%} confidence interval [CI] = 0.35-0.76, P = 0.001, I2 = 0{\%}), lower rate of heart failure readmission (RR = 0.58, 95{\%} CI = 0.46-0.74, P < 0.001, I2 = 0{\%}) and lower rate of AF recurrence (RR = 0.33, 95{\%} CI = 0.22-0.50, P < 0.001, I2 = 68{\%}) as compared to standard medical therapy. Surrogate outcomes showed a similar benefit favoring CA. Conclusion and Relevance: Catheter ablation for AF in HFrEF is associated with improvement in patient-centered outcomes and surrogate outcomes when compared to standard medical therapy with or without device therapy.",
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T2 - A systematic review and meta-analysis

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AU - Lee, Justin Z.

AU - Amin, Mustapha

AU - Al-Saffar, Farah

AU - Goel, Vasudha

AU - Tseng, Andrew

AU - Almader-Douglas, Diana

AU - Killu, Ammar M.

AU - Deshmukh, Abhishek J.

AU - Del-Carpio Munoz, Freddy

AU - Mulpuru, Siva

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KW - systolic heart failure

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