Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials

David F. Briceño; Timothy M. Markman; Florentino Lupercio; Jorge Romero; Jackson J. Liang; Pedro A. Villablanca; Edo Y. Birati; Fermin C. Garcia; Luigi Di Biase; Andrea Natale; Francis E. Marchlinski; Pasquale Santangeli

doi:10.1007/s10840-018-0425-0

Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials

David F. Briceño, Timothy M. Markman, Florentino Lupercio, Jorge Romero, Jackson J. Liang, Pedro A. Villablanca, Edo Y. Birati, Fermin C. Garcia, Luigi Di Biase, Andrea Natale, Francis E. Marchlinski, Pasquale Santangeli

Research output: Contribution to journal › Article › peer-review

36 Scopus citations

Abstract

Purpose: To evaluate whether catheter ablation is superior to conventional therapy for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). Methods: Electronic databases were searched for randomized, controlled trials of AF ablation compared with conventional therapy in adults with AF and HFrEF. Odds ratio (OR), standard mean difference (SMD), and 95% confidence intervals (CIs) were measured using the Mantel-Haenszel method. Results: There were seven trials including 856 patients (mean age 62 years, male 86%). All-cause mortality in patients who underwent ablation was 10% vs. 19% in those who received conventional treatment (four trials, 668 patients, 47% relative reduction, 9% absolute reduction; OR 0.46, 95% CI 0.29–0.72). Improvement in the left ventricular ejection fraction was significantly higher for patients undergoing ablation (+ 9 ± 10%) compared to conventional treatment (+ 2 ± 7%) (seven trials, 856 patients, SMD 0.68, 95% CI 0.28–1.08). Freedom from AF was higher in patients undergoing ablation (seven trials, 856 patients, 70% vs. 18%, respectively; 64% relative reduction, 52% absolute reduction; OR 0.03 95% CI 0.01–0.11). There was no significant difference in major complications between both strategies (OR 1.13, 95% CI 0.58–2.20). Conclusions: Catheter ablation for AF in patients with HFrEF decreases mortality and AF recurrence and improves left ventricular function, functional capacity, and quality of life, when compared to conventional management, without increasing complications.

Original language	English
Pages (from-to)	19-29
Number of pages	11
Journal	Journal of Interventional Cardiac Electrophysiology
Volume	53
Issue number	1
DOIs	https://doi.org/10.1007/s10840-018-0425-0
State	Published - 1 Oct 2018
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2018, Springer Science+Business Media, LLC, part of Springer Nature.

Funding

Conflict of interest Dr. Di Biase is a consultant for Biosense Webster, Boston Scientific, and St. Jude Medical and has received speaker honoraria/travel from Medtronic, Atricure, EPiEP, and Biotronik. Dr. Natale is a consultant for Biosense Webster, Stereotaxis, and St Jude Medical. Natale received speaker honoraria/travel from Medtronic, Atricure, EPiEP Biotronik, and Janssen. Dr. Marchlinski is a consultant for Abbot/St Jude Medical; Biotronik; Biosense Webster, Inc.; Infobionics; Medtronic, Inc.; and Boston Scientific Corp. and receives research grant from Biosense Webster, Inc. and fellowship support from Abbot/St Jude Medical; Biotronik; Biosense Webster, Inc.; Medtronic, Inc.; and Boston Scientific Corp. The remaining authors have no disclosures. Dr. Di Biase is a consultant for Biosense Webster, Boston Scientific, and St. Jude Medical and has received speaker honoraria/travel from Medtronic, Atricure, EPiEP, and Biotronik. Dr. Natale is a consultant for Biosense Webster, Stereotaxis, and St Jude Medical. Natale received speaker honoraria/travel from Medtronic, Atricure, EPiEP Biotronik, and Janssen. Dr. Marchlinski is a consultant for Abbot/St Jude Medical; Biotronik; Biosense Webster, Inc.; Infobionics; Medtronic, Inc.; and Boston Scientific Corp. and receives research grant from Biosense Webster, Inc. and fellowship support from Abbot/St Jude Medical; Biotronik; Biosense Webster, Inc.; Medtronic, Inc.; and Boston Scientific Corp. The remaining authors have no disclosures.

Funders	Funder number
Abbot/St Jude Medical
Biosense Webster, Inc.
EPiEP Biotronik
Medtronic
St. Jude Medical
Biosense Webster
Boston Scientific Corporation
Janssen Pharmaceuticals
Biotronik

Keywords

Atrial fibrillation
Catheter ablation
Heart failure with reduced ejection fraction
Meta-analysis
Randomized controlled trial
Systolic heart failure

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10.1007/s10840-018-0425-0

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Briceño, D. F., Markman, T. M., Lupercio, F., Romero, J., Liang, J. J., Villablanca, P. A., Birati, E. Y., Garcia, F. C., Di Biase, L., Natale, A., Marchlinski, F. E., & Santangeli, P. (2018). Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials. Journal of Interventional Cardiac Electrophysiology, 53(1), 19-29. https://doi.org/10.1007/s10840-018-0425-0

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title = "Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials",

abstract = "Purpose: To evaluate whether catheter ablation is superior to conventional therapy for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). Methods: Electronic databases were searched for randomized, controlled trials of AF ablation compared with conventional therapy in adults with AF and HFrEF. Odds ratio (OR), standard mean difference (SMD), and 95% confidence intervals (CIs) were measured using the Mantel-Haenszel method. Results: There were seven trials including 856 patients (mean age 62 years, male 86%). All-cause mortality in patients who underwent ablation was 10% vs. 19% in those who received conventional treatment (four trials, 668 patients, 47% relative reduction, 9% absolute reduction; OR 0.46, 95% CI 0.29–0.72). Improvement in the left ventricular ejection fraction was significantly higher for patients undergoing ablation (+ 9 ± 10%) compared to conventional treatment (+ 2 ± 7%) (seven trials, 856 patients, SMD 0.68, 95% CI 0.28–1.08). Freedom from AF was higher in patients undergoing ablation (seven trials, 856 patients, 70% vs. 18%, respectively; 64% relative reduction, 52% absolute reduction; OR 0.03 95% CI 0.01–0.11). There was no significant difference in major complications between both strategies (OR 1.13, 95% CI 0.58–2.20). Conclusions: Catheter ablation for AF in patients with HFrEF decreases mortality and AF recurrence and improves left ventricular function, functional capacity, and quality of life, when compared to conventional management, without increasing complications.",

keywords = "Atrial fibrillation, Catheter ablation, Heart failure with reduced ejection fraction, Meta-analysis, Randomized controlled trial, Systolic heart failure",

author = "Brice{\~n}o, {David F.} and Markman, {Timothy M.} and Florentino Lupercio and Jorge Romero and Liang, {Jackson J.} and Villablanca, {Pedro A.} and Birati, {Edo Y.} and Garcia, {Fermin C.} and {Di Biase}, Luigi and Andrea Natale and Marchlinski, {Francis E.} and Pasquale Santangeli",

note = "Publisher Copyright: {\textcopyright} 2018, Springer Science+Business Media, LLC, part of Springer Nature.",

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Briceño, DF, Markman, TM, Lupercio, F, Romero, J, Liang, JJ, Villablanca, PA, Birati, EY, Garcia, FC, Di Biase, L, Natale, A, Marchlinski, FE & Santangeli, P 2018, 'Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials', Journal of Interventional Cardiac Electrophysiology, vol. 53, no. 1, pp. 19-29. https://doi.org/10.1007/s10840-018-0425-0

Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials. / Briceño, David F.; Markman, Timothy M.; Lupercio, Florentino et al.
In: Journal of Interventional Cardiac Electrophysiology, Vol. 53, No. 1, 01.10.2018, p. 19-29.

Research output: Contribution to journal › Article › peer-review

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T1 - Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction

T2 - a systematic review and meta-analysis of randomized controlled trials

AU - Briceño, David F.

AU - Markman, Timothy M.

AU - Lupercio, Florentino

AU - Romero, Jorge

AU - Liang, Jackson J.

AU - Villablanca, Pedro A.

AU - Birati, Edo Y.

AU - Garcia, Fermin C.

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Marchlinski, Francis E.

AU - Santangeli, Pasquale

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Purpose: To evaluate whether catheter ablation is superior to conventional therapy for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). Methods: Electronic databases were searched for randomized, controlled trials of AF ablation compared with conventional therapy in adults with AF and HFrEF. Odds ratio (OR), standard mean difference (SMD), and 95% confidence intervals (CIs) were measured using the Mantel-Haenszel method. Results: There were seven trials including 856 patients (mean age 62 years, male 86%). All-cause mortality in patients who underwent ablation was 10% vs. 19% in those who received conventional treatment (four trials, 668 patients, 47% relative reduction, 9% absolute reduction; OR 0.46, 95% CI 0.29–0.72). Improvement in the left ventricular ejection fraction was significantly higher for patients undergoing ablation (+ 9 ± 10%) compared to conventional treatment (+ 2 ± 7%) (seven trials, 856 patients, SMD 0.68, 95% CI 0.28–1.08). Freedom from AF was higher in patients undergoing ablation (seven trials, 856 patients, 70% vs. 18%, respectively; 64% relative reduction, 52% absolute reduction; OR 0.03 95% CI 0.01–0.11). There was no significant difference in major complications between both strategies (OR 1.13, 95% CI 0.58–2.20). Conclusions: Catheter ablation for AF in patients with HFrEF decreases mortality and AF recurrence and improves left ventricular function, functional capacity, and quality of life, when compared to conventional management, without increasing complications.

AB - Purpose: To evaluate whether catheter ablation is superior to conventional therapy for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). Methods: Electronic databases were searched for randomized, controlled trials of AF ablation compared with conventional therapy in adults with AF and HFrEF. Odds ratio (OR), standard mean difference (SMD), and 95% confidence intervals (CIs) were measured using the Mantel-Haenszel method. Results: There were seven trials including 856 patients (mean age 62 years, male 86%). All-cause mortality in patients who underwent ablation was 10% vs. 19% in those who received conventional treatment (four trials, 668 patients, 47% relative reduction, 9% absolute reduction; OR 0.46, 95% CI 0.29–0.72). Improvement in the left ventricular ejection fraction was significantly higher for patients undergoing ablation (+ 9 ± 10%) compared to conventional treatment (+ 2 ± 7%) (seven trials, 856 patients, SMD 0.68, 95% CI 0.28–1.08). Freedom from AF was higher in patients undergoing ablation (seven trials, 856 patients, 70% vs. 18%, respectively; 64% relative reduction, 52% absolute reduction; OR 0.03 95% CI 0.01–0.11). There was no significant difference in major complications between both strategies (OR 1.13, 95% CI 0.58–2.20). Conclusions: Catheter ablation for AF in patients with HFrEF decreases mortality and AF recurrence and improves left ventricular function, functional capacity, and quality of life, when compared to conventional management, without increasing complications.

KW - Atrial fibrillation

KW - Catheter ablation

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KW - Meta-analysis

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KW - Systolic heart failure

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Briceño DF, Markman TM, Lupercio F, Romero J, Liang JJ, Villablanca PA et al. Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials. Journal of Interventional Cardiac Electrophysiology. 2018 Oct 1;53(1):19-29. doi: 10.1007/s10840-018-0425-0

Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials

Abstract

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Keywords

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