P826Rhythm versus rate control in patients with atrial fibrillation combined with left ventricular systolic dysfunction: a meta-analysis

Abstract

Background: Atrial fibrillation (AF) frequently coexists with heart failure (HF) with reduced ejection fraction (EF). Whether rhythm control is superior to rate control in patients with AF combined with HF is still controversial. Objective: This meta‐analysis was sought to compare AF control strategies (rhythm vs. rate and catheter ablation (CA) vs. antiarrhythmic agent (AAD)). Methods: We conducted a meta‐analysis of randomized controlled trials (RCT) comparing rhythm vs. rate control in patients with AF combined with HF. Mortality, HF hospitalization, cardiac remodeling outcomes including left ventricular EF and left atrial (LA) size, VO2 max and Minnesota living with HF questionnaire (MLHFQ) scores were compared. Results: Twelve RCTs with 5190 patients were included in this analysis. A total of 2598 patients (50.1%) were treated with rhythm control: medical therapy (2483, 95.6%) or catheter ablation (115, 4.4%). Mean follow‐up was 22.6 months. In random‐effect model, rhythm control was associated with increased LVEF (mean difference 6.60%; 95% CI 4.87 to 8.33), better exercise capacity (mean difference in VO2 max 3.60ml/ kg/min, 95% CI 1.53 to 5.66) and better quality of life (mean difference in MLHFQ score ‐13.18; 95% CI ‐22.83 to ‐3.54) compared with rate control group. LA size and LV end‐systolic volume decreased significantly in CA rather than AAD group. However, mortality, HF hospitalization rate were not different between two groups. Conclusion: In patients with AF combined with HF, even though mortality and HF hospitalization rate were similar, rhythm control strategy was superior to rate control in terms of improvement in LVEF, exercise capacity and quality of life. CA group was superior to AAD group regarding reverse cardiac remodeling.