AUTHOR=Lee Wei-Chieh , Fang Hsiu-Yu , Wu Po-Jui , Chen Huang-Chung , Fang Yen-Nan , Chen Mien-Cheng 

TITLE=Outcomes of catheter ablation vs. medical treatment for atrial fibrillation and heart failure: a meta-analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1165011

DOI=10.3389/fcvm.2023.1165011

ISSN=2297-055X

ABSTRACT=Background 
The benefit of catheter ablation versus medical treatment has been reported to be inconsistent in randomized controlled trials (RCTs) for patients with atrial fibrillation (AF) and heart failure (HF) due to different enrollment criteria. This meta-analysis aimed to decipher the differential outcomes, which stratified by different left ventricular ejection fractions (LVEFs) and AF types.

Methods
We searched PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials.gov databases for RCTs comparing medical treatment and catheter ablation in patients with AF and HF published before March 31, 2023. Nine studies were included. 

Results	
When patients were stratified by LVEF, improved LVEF and 6-min walk distance, less AF recurrence and lower all-cause mortality in favor of catheter ablation were observed in patients with LVEF ≤50%, but not in patients with LVEF ≤35%, and less HF hospitalization was observed in patients with LVEF ≤50% and LVEF ≤35%. When patients were stratified by AF types, improved LVEF and 6-min walk distance, better HF questionnaire score and less HF hospitalization in favor of catheter ablation were observed both in patients with non-paroxysmal AF and mixed AF (paroxysmal and persistent), and less AF recurrence and lower all-cause mortality in favor of catheter ablation were only observed in patients with mixed AF. 

Conclusions
This meta-analysis showed improved LVEF, and 6-min walk distance, less AF recurrence and lower all-cause mortality in favor of catheter ablation versus medical treatment in AF patients with HF and LVEF of 36-50%. Compared with medical treatment, catheter ablation improved LVEF and had better HF status in patients with non-paroxysmal AF and mixed AF; however, AF recurrence and all-cause mortality in favor of catheter ablation were only observed in HF patients with mixed AF.