Cited by 174Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studies

Catheter Ablation of Atrial Fibrillation in Patients With Left Ventricular Systolic Dysfunction: A Systematic Review and Meta-Analysis

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Anselmino, Matteo, Matta, Mario, D’Ascenzo, Fabrizio, Bunch, T. Jared, Schilling, Richard J., Hunter, Ross J., Pappone, Carlo, Neumann, Thomas +10 more·2014·Circulation Arrhythmia and Electrophysiology

Abstract

BACKGROUND: Catheter ablation of atrial fibrillation (AFCA) is an established therapeutic option for rhythm control in symptomatic patients. Its efficacy and safety among patients with left ventricular systolic dysfunction is based on small populations, and data concerning long-term outcome are limited. We performed this meta-analysis to assess safety and long-term outcome of AFCA in patients with left ventricular systolic dysfunction, to evaluate predictors of recurrence and impact on left ventricular function. METHODS AND RESULTS: A systematic review was conducted in MEDLINE/PubMed and Cochrane Library. Randomized controlled trials, clinical trials, and observational studies including patients with left ventricular systolic dysfunction undergoing AFCA were included. Twenty-six studies were selected, including 1838 patients. Mean follow-up was 23 (95% confidence interval, 18-40) months. Overall complication rate was 4.2% (3.6%-4.8%). Efficacy in maintaining sinus rhythm at follow-up end was 60% (54%-67%). Meta-regression analysis revealed that time since first atrial fibrillation (P=0.030) and heart failure (P=0.045) diagnosis related to higher, whereas absence of known structural heart disease (P=0.003) to lower incidence of atrial fibrillation recurrences. Left ventricular ejection fraction improved significantly during follow-up by 13% (P<0.001), with a significant reduction of patients presenting an ejection fraction <35% (P<0.001). N-terminal pro-brain natriuretic peptide blood levels decreased by 620 pg/mL (P<0.001). CONCLUSIONS: AFCA efficacy in patients with impaired left ventricular systolic function improves when performed early in the natural history of atrial fibrillation and heart failure. AFCA provides long-term benefits on left ventricular function, significantly reducing the number of patients with severely impaired systolic function.

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Crossref · 10.1161/circep.114.001938

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Authors
Anselmino, M., Matta, M., D’Ascenzo, F., Bunch, T. J., Schilling, R. J., Hunter, R. J., Pappone, C., Neumann, T., Noelker, G., Fiala, M., Bertaglia, E., Frontera, A., Duncan, E., Nalliah, C., Jais, P., Weerasooriya, R., Kalman, J. M., & Gaita, F.
Affiliations
  • St Bartholomew's Hospital (GB)
  • From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care &amp; Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff...
Venue
Circulation Arrhythmia and Electrophysiology
Published
2014-12
Volume
7
Issue
6
Pages
1011-1018
ISSN
  • 1941-3084 (ISSN-L)
  • 1941-3149
OpenAlex
W2133964800
Cited by
174
References
48
Citations by year
2026: 4 · 2025: 4 · 2024: 5 · 2023: 9 · 2022: 5 · 2021: 14 · 2020: 17 · 2019: 21 · 2018: 32 · 2017: 21 · 2016: 14 · 2015: 20 · 2014: 2 · 2013: 3 · 2012: 1
FWCI
13.06
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Circulation Arrhythmia and Electrophysiology (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by)
  • Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
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
catheter ablation, atrial fibrillation, left ventricular systolic dysfunction, atrial fibrillation recurrence, procedural complications, left ventricular ejection fraction, heart failure, natriuretic peptides, structural heart disease, sinus rhythm maintenance, timing of ablation
MeSH terms
Atrial Fibrillation, Female, Humans, Male, Middle Aged, Peptide Fragments, Recurrence, Risk Factors, Stroke Volume, Systole, Time Factors, Biomarkers, Chi-Square Distribution, Odds Ratio, Ventricular Function, Left, Treatment Outcome, Catheter Ablation, Ventricular Dysfunction, Left, Natriuretic Peptide, Brain, Recovery of Function

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