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Catheter Ablation for Atrial Fibrillation in Heart Failure Patients
Open accessAbstract
Background Rhythm control with antiarrhythmic drugs (AADs) is not superior to rate control in patients with heart failure (HF) and atrial fibrillation (AF), but AF ablation may be more successful at achieving rhythm control than AADs. However, risks for both ablation and AADs are likely higher and success rates lower in patients with HF.Objective To compare rate control versus AF catheter ablation strategies in patients with AF and HF.Methods We conducted a meta-analysis of trials which randomized HF patients (LVEF<50%) with AF to a rate control or AF catheter ablation strategy and reported change in LVEF, quality of life, 6-minute walk test, or peak oxygen consumption. Study quality and heterogenity were assessed using Jadad scores and Cochran's Q statistics, respectively. Mantel Haenszel relative risks and mean differences were calculated using random effect models.Results Four trials (N=224) met inclusion criteria; 82.5% (n=185) had persistent AF. AF ablation was associated with an increase in LVEF (mean difference 8.5%; 95%CI 6.4,10.7%; P<0.001) compared to rate control. AF ablation was superior in improving quality of life by Minnesota Living with Heart Failure (MLWHF) questionnaire scores (mean difference -11.9; 95%CI -17.1, -6.6; P<0.001). Peak oxygen consumption and 6-minute walk distance increased in AF ablation compared to rate control patients (mean difference 3.2; 95%CI 1.1,5.2; P=0.003; mean difference 34.8; 95%CI 2.9, 66.7; P = 0.03, respectively). In the persistent AF subgroup LVEF and MLWHF were significantly improved with AF ablation. Major adverse event rates (RR 1.3; 95% CI, 0.4, 3.9; p=0.64) were not significantly different. No significant heterogeneity was evident.Conclusions In patients with HF and AF, AF catheter ablation is superior to rate control in improving LVEF, quality of life and functional capacity. Prior to accepting a rate control strategy in HF patients with persistent or drug refractory AF, consideration should be given to AF ablation.
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Metadata
- Authors
- Al Halabi, S., Qintar, M., Hussein, A., Alraies, M. C., Jones, D. G., Wong, T., MacDonald, M. R., Petrie, M. C., Cantillon, D., Tarakji, K. G., Kanj, M., Bhargava, M., Varma, N., Baranowski, B., Wilkoff, B. L., Wazni, O., Callahan, T., Saliba, W., & Chung, M. K.
- Affiliations
- Cleveland Clinic (US)
- University of Minnesota (US)
- National Health Service (GB)
- Golden Jubilee National Hospital (GB)
- Corresponding author
- Chung, Mina K.
- ORCID
- Venue
- JACC. Clinical electrophysiology
- Publisher
- Elsevier BV
- Published
- 2015-06
- Volume
- 1
- Issue
- 3
- Pages
- 200-209
- ISSN
- 2405-500X (ISSN-L)
- PMC
- PMC4525704
- OpenAlex
- W952936096
- Cited by
- 105
- References
- 42
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 9 · 2023: 4 · 2022: 6 · 2021: 12 · 2020: 11 · 2019: 19 · 2018: 17 · 2017: 14 · 2016: 6 · 2015: 1
- FWCI
- 9.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC. Clinical electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Funders
- National Institutes of Health (R01HL111314)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, heart failure, catheter ablation, rate control, antiarrhythmic drugs, left ventricular ejection fraction, quality of life, functional capacity, persistent atrial fibrillation, major adverse events, Minnesota Living with Heart Failure Questionnaire, 6-minute walk test, peak oxygen uptake, drug-refractory atrial fibrillation
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