- In patients with Afib and heart failure (HF), ablation yielded better outcomes than drug therapy in this meta-analysis.
- Additional trials of catheter ablation are underway.
Why this matters
- Guidelines on ablation call for caution with diminished ejection fraction (EF) or left ventricular (LV) systolic dysfunction.
- All trials used radiofrequency ablation catheters to perform pulmonary vein isolation.
- Drug therapy strategies included both rate and rhythm control.
- Ablation vs drug therapy (95% CIs):
- All-cause mortality: 9.0% vs 17.6%; risk ratio (RR), 0.52 (0.33-0.81);
- HF hospitalization: 16.4% vs 27.6%; RR, 0.60 (0.39-0.93);
- LVEF improvement, difference: 6.95% (3.0-10.9);
- 6-minute walk test improvement, difference: 20.93 m (5.91-35.95);
- Improvement in VO2max: 3.17 mL/kg/minute (1.26-5.07);
- Improvement in QoL score: −9.02 points (−19.75 to 1.71 points);
- Afib-free survival: 72% vs 22%;
- No between-group significant difference in serious adverse events.
- Meta-analysis of 6 randomized controlled trials comparing ablation to drug therapy for adults with Afib and HF (n=775).
- Follow-up, 6-60 months.
- Outcomes included all-cause mortality, HF hospitalization, serious adverse events.
- Funding: None.
- Potential for selection bias.
- Most participants relatively young; results might not apply to older patients.