Compared with standard drug therapy, catheter ablation improved all-cause mortality and quality of life in patients with atrial fibrillation and heart failure, according to findings published in Annals of Internal Medicine.
“Atrial fibrillation is associated with thromboembolic stroke, systemic embolism and decompensated heart failure requiring hospitalization,” Mohit K. Turagam, MD, from Mount Sinai Hospital, and colleagues wrote.
“Catheter ablation is an established therapeutic strategy for symptomatic, drug-refractory atrial fibrillation,” they added. “However, current guidelines support atrial fibrillation ablation with caution” in certain patients.
Turagam and colleagues reviewed six randomized controlled trials to compare the benefits and harms of catheter ablation vs. standard drug therapy (rate or rhythm control medications) for adult patients with atrial fibrillation and heart failure (n = 775).
The researchers found that treatment with atrial fibrillation ablation decreased all-cause mortality (9% vs. 17.6%; RR = 0.52; 95% CI, 0.33-0.81) and heart failure hospitalizations (16.4% vs. 27.6%; RR = 0.6; 95% CI, 0.39-0.93) compared with drug therapy.
Patients treated with ablation showed improvements in left ventricular ejection fraction (mean difference, 6.95%; 95% CI, 3-10.9), 6-minute walk test distance (mean difference, 20.93 m; 95% CI, 5.91-35.95), peak oxygen consumption (mean difference, 3.17 mL/kg per minute; 95% CI, 1.26-5.07) and quality of life (mean difference in Minnesota Living with Heart Failure Questionnaire score, –9.02 points; 95% CI, –19.75 to 1.71).
Patients in the ablation groups were more likely to experience serious adverse events than those in the drug therapy groups, but differences were not statistically significant (7.2% vs. 3.8%; RR = 1.68; 95% CI, 0.58-4.85).
“The long-term benefits in all-cause mortality, heart failure hospitalizations and overall clinical outcomes must be weighed in clinical decision making,” Turagam and colleagues concluded. – by Alaina Tedesco
Disclosures: Turagam reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.