Author + information
- Mohammad-Ali Jazayeri,
- Venkat Lakshmi Kishan Vuddanda,
- Valay Parikh,
- Madhav Lavu,
- Mohit Turagam,
- M. Rizwan Afzal,
- Donita Atkins,
- Sudharani Bommana,
- Luigi Di Biase,
- Andrea Natale,
- Madhu Reddy and
- Dhanunjaya Lakkireddy
Background: Atrial fibrillation (AF) is common source of morbidity in heart failure (HF) with reduced left ventricular ejection fraction (LVEF). Small studies have shown catheter ablation (CA) to be superior to conservative therapy for improvement in LVEF and quality of life (QoL) measures. We sought to synthesize available data to more precisely estimate CA impact on these outcomes.
Methods: Systematic review of MEDLINE, EMBASE, and CINAHL databases was completed through October 2016 for studies of CA versus medical management or AV nodal ablation and pacing in HF patients with AF. Quality and heterogeneity were assessed using the Jadad Scale and Cochrane Q (I2), respectively. Using an inverse variance method and random effects analysis, pooled effects were calculated.
Results: In 5 high quality randomized control trials, 396 AF patients (205 CA, 83 antiarrhythmic, 68 rate control, 40 ablate & pace) were studied: 81% were male, mean age was 60.9 ± 9.8 years and mean LVEF was 27.8 ± 7.4. In pooled analysis, CA led to a mean increase in LVEF of 6.7% (p = .002) and Minnesota Living with HF score reduction of 12.3 points (p = .003). Substantial heterogeneity was noted with addition of the AATAC trial, which increased patient count by 85%. Net outcomes were not impacted in sensitivity analyses (Figure).
Conclusions: CA of AF offers a modest benefit in LVEF and QoL over alternative therapies in HF with reduced LVEF. This effect remains significant even with comparison to a sizeable cohort on antiarrhythmic therapy.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Innovative Approaches for Reducing Risk and Improving Outcomes With Ablation
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1237-096
- 2017 American College of Cardiology Foundation