Meta-analysis of randomized controlled trials on atrial fibrillation ablation in patients with heart failure with reduced ejection fraction

Aiman Smer, Mohsin Salih, Yousef H. Darrat, Abdulghani Saadi, Raviteja Guddeti, Toufik Mahfood Haddad, Amjad Kabach, Mohamed Ayan, Alok Saurav, Hussam Abuissa, Claude S. Elayi

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Abstract

Background: The role of catheter ablation (CA) is increasingly recognized as a reasonable therapeutic option in patients with atrial fibrillation (AF) and heart failure (HF). Hypothesis: We aimed to compare CA to medical therapy in AF patients with HF with reduced ejection fraction (HFrEF). Methods: We searched the literature for randomized clinical trials comparing CA to medical therapy in this population. Results: Six trials with a total of 775 patients were included. AF was persistent in 95% of patients with a mean duration of 18.5 ± 23 months prior enrollment. The mean age was 62.2 ± 7.8 years, mostly males (83%) with mean left ventricular ejection fraction (LVEF) of 31.2 ± 6.7%. Compared to medical therapy, CA has significantly improved LVEF by 5.9% (Mean difference [MD] 5.93, confidence interval [CI] 3.59-8.27, P < 0.00001, I2 = 87%), quality of life, (MD −9.01, CI −15.56, −2.45, P = 0.007, I2 = 47%), and functional capacity (MD 25.82, CI 5.46-46.18, P = 0.01, I2 = 90%). CA has less HF hospital readmissions (odds ratio [OR] 0.5, CI 0.32-0.78, P = 0.002, I2 = 0%) and death from any cause (OR 0.46, CI 0.29-0.73, P = 0.0009, I2 = 0%). Freedom from AF during follow-up was higher in patients who had CA (OR 24.2, CI 6.94-84.41, P < 0.00001, I2 = 81%. Conclusion: CA was superior to medical therapy in patients with AF and HFrEF in terms of symptoms, hemodynamic response, and clinical outcomes by reducing AF burden. However, these findings are applicable to the very specific patients enrolled in these trials.

Original languageEnglish (US)
Pages (from-to)1430-1438
Number of pages9
JournalClinical Cardiology
Volume41
Issue number11
DOIs
StatePublished - Nov 1 2018

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Catheter Ablation
Atrial Fibrillation
Meta-Analysis
Randomized Controlled Trials
Heart Failure
Confidence Intervals
Odds Ratio
Stroke Volume
Therapeutics
Patient Readmission
Cause of Death
Hemodynamics
Quality of Life
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Smer, A., Salih, M., Darrat, Y. H., Saadi, A., Guddeti, R., Mahfood Haddad, T., ... Elayi, C. S. (2018). Meta-analysis of randomized controlled trials on atrial fibrillation ablation in patients with heart failure with reduced ejection fraction. Clinical Cardiology, 41(11), 1430-1438. https://doi.org/10.1002/clc.23068

Meta-analysis of randomized controlled trials on atrial fibrillation ablation in patients with heart failure with reduced ejection fraction. / Smer, Aiman; Salih, Mohsin; Darrat, Yousef H.; Saadi, Abdulghani; Guddeti, Raviteja; Mahfood Haddad, Toufik; Kabach, Amjad; Ayan, Mohamed; Saurav, Alok; Abuissa, Hussam; Elayi, Claude S.

In: Clinical Cardiology, Vol. 41, No. 11, 01.11.2018, p. 1430-1438.

Research output: Contribution to journalArticle

Smer, A, Salih, M, Darrat, YH, Saadi, A, Guddeti, R, Mahfood Haddad, T, Kabach, A, Ayan, M, Saurav, A, Abuissa, H & Elayi, CS 2018, 'Meta-analysis of randomized controlled trials on atrial fibrillation ablation in patients with heart failure with reduced ejection fraction', Clinical Cardiology, vol. 41, no. 11, pp. 1430-1438. https://doi.org/10.1002/clc.23068
Smer, Aiman ; Salih, Mohsin ; Darrat, Yousef H. ; Saadi, Abdulghani ; Guddeti, Raviteja ; Mahfood Haddad, Toufik ; Kabach, Amjad ; Ayan, Mohamed ; Saurav, Alok ; Abuissa, Hussam ; Elayi, Claude S. / Meta-analysis of randomized controlled trials on atrial fibrillation ablation in patients with heart failure with reduced ejection fraction. In: Clinical Cardiology. 2018 ; Vol. 41, No. 11. pp. 1430-1438.
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abstract = "Background: The role of catheter ablation (CA) is increasingly recognized as a reasonable therapeutic option in patients with atrial fibrillation (AF) and heart failure (HF). Hypothesis: We aimed to compare CA to medical therapy in AF patients with HF with reduced ejection fraction (HFrEF). Methods: We searched the literature for randomized clinical trials comparing CA to medical therapy in this population. Results: Six trials with a total of 775 patients were included. AF was persistent in 95{\%} of patients with a mean duration of 18.5 ± 23 months prior enrollment. The mean age was 62.2 ± 7.8 years, mostly males (83{\%}) with mean left ventricular ejection fraction (LVEF) of 31.2 ± 6.7{\%}. Compared to medical therapy, CA has significantly improved LVEF by 5.9{\%} (Mean difference [MD] 5.93, confidence interval [CI] 3.59-8.27, P < 0.00001, I2 = 87{\%}), quality of life, (MD −9.01, CI −15.56, −2.45, P = 0.007, I2 = 47{\%}), and functional capacity (MD 25.82, CI 5.46-46.18, P = 0.01, I2 = 90{\%}). CA has less HF hospital readmissions (odds ratio [OR] 0.5, CI 0.32-0.78, P = 0.002, I2 = 0{\%}) and death from any cause (OR 0.46, CI 0.29-0.73, P = 0.0009, I2 = 0{\%}). Freedom from AF during follow-up was higher in patients who had CA (OR 24.2, CI 6.94-84.41, P < 0.00001, I2 = 81{\%}. Conclusion: CA was superior to medical therapy in patients with AF and HFrEF in terms of symptoms, hemodynamic response, and clinical outcomes by reducing AF burden. However, these findings are applicable to the very specific patients enrolled in these trials.",
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AU - Smer, Aiman

AU - Salih, Mohsin

AU - Darrat, Yousef H.

AU - Saadi, Abdulghani

AU - Guddeti, Raviteja

AU - Mahfood Haddad, Toufik

AU - Kabach, Amjad

AU - Ayan, Mohamed

AU - Saurav, Alok

AU - Abuissa, Hussam

AU - Elayi, Claude S.

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