Catheter Ablation of Atrial Fibrillation in Patients With Left Ventricular Systolic Dysfunction: A Systematic Review and Meta-Analysis
Open accessAbstract
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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For patients who develop HFrEF as a result of rapid AF (tachycardiomyopathy), a rhythm control strategy is preferred, based on several relatively small patient cohorts and trials reporting improved LV function after restoration of sinus rhythm.
“For patients who develop HFrEF as a result of rapid AF (tachycardiomyopathy), a rhythm control strategy is preferred, based on several relatively small patient cohorts and trials reporting improved LV function after restoration of sinus rhythm.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [226]
Catheter ablation may be a useful method to restore LV function and quality of life in AF patients with HFrEF, but further data are needed.
“Catheter ablation may be a useful method to restore LV function and quality of life in AF patients with HFrEF, 185,[226][227][228] but further data are needed.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [226]
Catheter ablation or combination therapy is often effective when antiarrhythmic drugs fail.
“Catheter ablation or combination therapy is often effective when antiarrhythmic drugs fail.226,[585][586][587]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [226]
Several smaller trials suggest improved left ventricular function after catheter ablation in heart failure with reduced ejection fraction patients.
“Several smaller trials suggest improved LV function after catheter ablation in HFrEF patients 185, 226-228, 778, 779”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [226]
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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 & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff...
- ORCID
- 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
- green
- hdl.handle.net
- 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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