A meta-analysis of randomized controlled trials has found that catheter ablation was superior to conventional drug therapy alone for patients with atrial fibrillation (AFib) and heart failure.
AFib may lead to thromboembolic stroke, systemic embolism, and decompensated heart failure. Although catheter ablation is an established therapeutic strategy for AFib, guidelines recommend caution in certain patients, and the benefits and harms of catheter ablation versus drug therapy for Afib patients have not been firmly established.
Researchers from the Icahn School of Medicine at Mount Sinai reviewed six published randomized controlled trials to compare the benefits and harms of catheter ablation and standard drug therapy in adult patients with AFib and heart failure. Their analysis showed that compared to medication, catheter ablation was associated with reductions in all-cause mortality and heart failure hospitalizations and improvements in left ventricular ejection fraction; quality of life; cardiopulmonary exercise capacity; and six-minute walk test distance, with no statistically significant increase in serious adverse events. Their findings are published in Annals of Internal Medicine.
The researchers found a 7.2% major adverse event rate in the ablation group and a rate of 3.8% in the standard drug therapy group. Serious adverse events were more common in the ablation groups, although differences between the ablation and drug therapy groups were not statistically significant, the researchers found.
The authors reviewed six randomized controlled trials involving 775 patients, and the results were driven primarily by one clinical trial, possible patient selection bias in the ablation group, a lack of patient-level data, open-label trial designs, and heterogeneous follow-up length among trials. Despite the complications associated with catheter ablation, the authors explain that the long-term benefits in all-cause mortality, heart failure hospitalizations, and overall clinical outcomes must be weighed in clinical decision-making.
