HF with Afib: ablation outperforms drug therapy: meta-analysis

  • Turagam MK & al.
  • Ann Intern Med
  • 25 Dec 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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.

Limitations

  • Potential for selection bias.
  • Most participants relatively young; results might not apply to older patients.

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