Heart failure & cardiomyopathiesMeta-analysis
Atrial Fibrillation Ablation in Heart Failure With Reduced vs Preserved Ejection Fraction
- Systematic review and meta-analysis of randomised trials
- random-effects Mantel-Haenszel models
Authors' conclusion
This study found that catheter ablation for AF was associated with reduced risk of HF events in patients with HFrEF but had limited or no benefit in HFpEF.
Study context
- Population
- Patients with heart failure (HF), NYHA class II or greater, and paroxysmal or persistent atrial fibrillation (AF) (heart failure with reduced ejection fraction (HFrEF) n = 1552; HF with preserved ejection fraction (HFpEF) n = 913)
- Participants
- 2,465 patients · 12 randomized clinical trials (RCTs)
- Comparison
- Catheter ablation vs Conventional rate or rhythm control
- Outcome
- HF events:
- HF hospitalization
- Clinically significant worsening of HF
- Unscheduled visits for treatment intensification
Pooled result
As reported in the abstract
HF events by HF phenotype
Catheter ablation vs Conventional rate or rhythm controlRelative risk (95% CI)
HFrEF
0.59(0.48–0.72)
HFpEF
0.93(0.65–1.32)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| CV death by HF phenotype — Catheter ablation vs Conventional rate or rhythm control · HFrEF | 0.49 (0.34–0.70) | |
| CV death by HF phenotype — Catheter ablation vs Conventional rate or rhythm control · HFpEF | 0.91 (0.46–1.79) | |
| All-cause mortality by HF phenotype — Catheter ablation vs Conventional rate or rhythm control · HFrEF | 0.63 (0.47–0.86) | |
| All-cause mortality by HF phenotype — Catheter ablation vs Conventional rate or rhythm control · HFpEF | 0.95 (0.39–2.30) | |
| 0.20.5125Relative risk (log scale) |
- CV death by HF phenotype: P for interaction = .12
- All-cause mortality by HF phenotype: P for interaction = .39
Original publication
Atrial Fibrillation Ablation in Heart Failure With Reduced vs Preserved Ejection Fraction. JAMA Cardiol. Published 1 June 2024. doi:10.1001/jamacardio.2024.0675
Summarised from the published abstract; every number is checked against it