P4826Catheter ablation for atrial fibrillation in heart failure patients: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Atrial fibrillation (AF) often co-exists with heart failure. However, the efficacy of catheter ablation for AF in the context of heart failure remains controversial. We conducted a systematic review and meta-analysis of randomized controlled trials comparing catheter ablation (CA) to medical therapy. Methods: PubMed and Cochrane Library were searched to 4th February 2018. Results: A total of 650 and 84 studies were retrieved. Five trials (mean follow-up: 28 months) comprising 355 subjects in the CA arm (84% male, mean age: 63±8 years) and 354 subjects in the medical therapy arm (81% male, mean age: 63±9 years) were included. In the CA group, 38/78 (49%) and 250/352 (71%) patients were free from AF after the first and last procedures, respectively. CA reduced all-cause mortality (RR: 0.58, 95% CI: 0.45 to 0.75; P<0.0001; I2: 0%) but not allcause hospitalization (RR: 0.74, 95% CI: 0.43 to 1.28, P=0.28; I2: 79%). Changes in 6-minute walk test were not significantly different between the two groups (MD: 3.2, 95% CI: -0.3 to 6.7, P<0.075; I2: 12%). CA produced greater improvement in left ventricular ejection fraction (LVEF) (mean difference [MD] 3.5%, 95% CI: 2.4 to 4.7%, P<0.0001; I2: 0%) and decreased the left atrial area (MD: -445 mm2, 95% CI: -787 to -103 mm2, P<0.05; I2: 66%) and the left atrial diameter (MD: -1.6 mm, 95% CI: -3.2 to -0.03, P<0.05, I2: 5%) to greater extents compared to medical therapy. Conclusions: CA reduces mortality, improves LVEF and reduces left atrial size compared to medical therapy for treating AF in heart failure patients.