Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Background: Catheter ablation (CA) for atrial fibrillation (AF) has been proposed as a means of improving outcomes among patients with heart failure and reduced ejection fraction (HFrEF) who are otherwise receiving appropriate treatment. Unlike HFrEF, treatment options are more limited in patients with preserved ejection fraction (HFpEF) and the data pertaining to the management of AF in these patients are controversial. The aim of this systematic review and meta-analysis was to investigate the effects of CA on outcomes of patients with AF and HFpEF, such as functional status, post-procedural complications, hospitalization, morbidity and mortality, based on data from observational studies. Methods: We systematically searched the electronic databases MEDLINE, PUBMED, EMBASE and the Cochrane Library for Central Register of Clinical Trials until May 2020. Results: Overall, the pooling of our data showed that sinus rhythm was achieved long-term in 58.0% (95% CI 0.44–0.71). Long-term AF recurrence was noticed in 22.3% of patients. Admission for HF occurred in 6.2% (95% CI 0.04–0.09) whilst all-cause mortality was identified in 6.3% (95% CI 0.02–0.13). Conclusion: This meta-analysis is the first to focus on determining the benefits of a rhythm control strategy for patients with AF and HFpEF using CA, suggesting it may be worthwhile to investigate the effects of a CA rhythm control strategy as the default treatment of AF in HFpEF patients in randomized trials.

[1]  D. Choi,et al.  Impact of atrial fibrillation in patients with heart failure and reduced, mid-range or preserved ejection fraction , 2020, Heart.

[2]  B. Borlaug Evaluation and management of heart failure with preserved ejection fraction , 2020, Nature Reviews Cardiology.

[3]  J. García-Fernández,et al.  Biomarkers in atrial fibrillation and heart failure with non-reduced ejection fraction: Diagnostic application and new cut-off points. , 2020, Heart & lung : the journal of critical care.

[4]  P. Ponikowski,et al.  How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) , 2020, European journal of heart failure.

[5]  Kazuhiro Yamamoto,et al.  Differential Prognostic Impact of Atrial Fibrillation in Hospitalized Heart Failure Patients With Preserved Ejection Fraction According to Coronary Artery Disease Status - Report From the Japanese Nationwide Multicenter Registry. , 2020, Circulation journal : official journal of the Japanese Circulation Society.

[6]  N. Takahashi,et al.  Catheter ablation of atrial fibrillation reduces heart failure rehospitalization in patients with heart failure with preserved ejection fraction , 2020, Journal of cardiovascular electrophysiology.

[7]  Jacob P. Kelly,et al.  Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines—Heart Failure , 2019, Journal of the American Heart Association.

[8]  J. Spertus,et al.  Comparison of the Effect of Catheter Ablation for Atrial Fibrillation on All-Cause Hospitalization in Patients With Versus Without Heart Failure (from the Nationwide Readmission Database). , 2019, The American journal of cardiology.

[9]  K. Aonuma,et al.  Relationships between maintenance of sinus rhythm and clinical outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation. , 2019, Journal of cardiology.

[10]  Snehal R. Patel,et al.  Efficacy of Catheter Ablation of Atrial Fibrillation in Heart Failure with Preserved Ejection Fraction , 2019, Journal of Cardiac Failure.

[11]  G. Hindricks,et al.  Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial , 2019, JAMA.

[12]  J. Brachmann,et al.  Atrial fibrillation ablation strategies and outcome in patients with heart failure: insights from the German ablation registry , 2019, Clinical Research in Cardiology.

[13]  M. Diez,et al.  Atrial Fibrillation in Heart Failure Patients with Preserved or Reduced Ejection Fraction. Prognostic significance of Rhythm control strategy with Catheter Ablation. , 2019, Journal of atrial fibrillation.

[14]  H. Hachiya,et al.  Impact of catheter ablation of atrial fibrillation on long-term clinical outcomes in patients with heart failure. , 2018, Journal of cardiology.

[15]  F. Brozovich,et al.  HFpEF, a Disease of the Vasculature: A Closer Look at the Other Half , 2018, Mayo Clinic proceedings.

[16]  Timothy M. Markman,et al.  Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials , 2018, Journal of Interventional Cardiac Electrophysiology.

[17]  J. P. Piccini,et al.  Mineralocorticoid Receptor Antagonism for the Treatment of AF and HFpEF: Preserving Hope. , 2018, JACC. Heart failure.

[18]  S. Saksena,et al.  Atrial resynchronization therapy in patients with atrial fibrillation and heart failure with and without systolic left ventricular dysfunction: a pilot study , 2018, Journal of Interventional Cardiac Electrophysiology.

[19]  R. Ochani,et al.  Atrial fibrillation and heart failure- results of the CASTLE-AF trial , 2018, Journal of community hospital internal medicine perspectives.

[20]  M. Yoshiyama,et al.  Prevalence and Prognostic Significance of Functional Mitral and Tricuspid Regurgitation Despite Preserved Left Ventricular Ejection Fraction in Atrial Fibrillation Patients. , 2018, Circulation journal : official journal of the Japanese Circulation Society.

[21]  M. Ishihara,et al.  Left atrial ejection force predicts the outcome after catheter ablation for paroxysmal atrial fibrillation , 2018, Journal of cardiovascular electrophysiology.

[22]  Kevin L. Thomas,et al.  Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction. , 2017, Heart rhythm.

[23]  Deepak L. Bhatt,et al.  Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction: 5-Year Outcomes. , 2017, Journal of the American College of Cardiology.

[24]  P. Ponikowski,et al.  2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure , 2016, Revista espanola de cardiologia.

[25]  Sanjiv J. Shah,et al.  Spironolactone for Management of Heart Failure with Preserved Ejection Fraction: Whither to After TOPCAT? , 2015, Current Atherosclerosis Reports.

[26]  K. Aonuma,et al.  Efficacy, safety, and outcomes of catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction. , 2013, Journal of the American College of Cardiology.

[27]  M. O'Neill,et al.  Catheter ablation of atrial fibrillation in heart failure. , 2013, Heart failure clinics.

[28]  D. Packer,et al.  Success of Ablation for Atrial Fibrillation in Isolated Left Ventricular Diastolic Dysfunction: A Comparison to Systolic Dysfunction and Normal Ventricular Function , 2011, Circulation. Arrhythmia and electrophysiology.

[29]  Mendel Suchmacher,et al.  Systematic reviews and meta-analyses , 2019, Practical Biostatistics.

[30]  Dick Menzies Systematic reviews and meta-analyses. , 2011, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[31]  D. Callans,et al.  Atrial Fibrillation and Heart Failure: Treatment Considerations for a Dual Epidemic , 2009, Circulation.

[32]  C. Schneider,et al.  ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: application of natriuretic peptides. , 2008, European heart journal.

[33]  K. Dickstein,et al.  How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. , 2007, European heart journal.

[34]  A. Goette,et al.  Effect of successful electrical cardioversion on serum aldosterone in patients with persistent atrial fibrillation. , 2001, The American journal of cardiology.

[35]  T. Zolotarova,et al.  PREDICTORS OF ATRIAL FIBRILLATION RECURRENCE AFTER RADIOFREQUENCY ABLATION IN PATIENTS WITH CHRONIC HEART FAILURE. , 2021, Wiadomosci lekarskie.