Catheter ablation versus medical therapy for atrial fibrillation in patients with heart failure with preserved ejection fraction: A systematic review and meta-analysis.
| Autor: | Bulhões E; College of Higher Education of the United Amazon, Medicine Department, Redenção, Pará, Brazil., Antunes VLJ; Federal University of Health Sciences of Porto Alegre, Medicine Department, Porto Alegre, Rio Grande do Sul, Brazil., Mazetto R; Amazonas State University, Medicine Department, Manaus, Amazonas, Brazil., Defante MLR; Redentor University Center, Medicine Department, Itaperuna, Rio de Janeiro, Brazil., Garcia AC; Goiás Military Police Hospital, Division of Cardiology, Goiânia, Goiás, Brazil., Guida C; Dante Pazzanese Institute of Cardiology, Division of Cardiology, São Paulo, São Paulo, Brazil. Electronic address: camila.mguida@gmail.com. |
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| Jazyk: | angličtina |
| Zdroj: | Heart rhythm [Heart Rhythm] 2024 Sep; Vol. 21 (9), pp. 1595-1603. Date of Electronic Publication: 2024 Apr 15. |
| DOI: | 10.1016/j.hrthm.2024.04.058 |
| Abstrakt: | Background: The benefit of catheter ablation for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) remains uncertain. Objective: We performed a systematic review and meta-analysis to compare catheter ablation and medical therapy (antiarrhythmics for rhythm or rate control) in patients with AF and HFpEF. Methods: We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials. Outcomes were the composite end points of death or heart failure (HF) hospitalization, all-cause death, cardiovascular death, all-cause rehospitalization, and HF hospitalization. Statistical analysis was performed using R statistical software, version 4.3.2 (R Foundation for Statistical Computing). Heterogeneity was assessed with I 2 statistics. Results: We included 20,257 patients from 8 studies. Of those, 3 were derived from RCTs, either through post hoc analysis or subgroup analysis, and 5 were observational studies. The median follow-up ranged from 24.6 to 61.2 months. Compared with medical therapy, catheter ablation was associated with a statistically significant lower risk of death or HF hospitalization (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.47-0.83; P = .001; I 2 = 66%), all-cause death (HR 0.68; 95% CI 0.46-0.99; P = .047; I 2 = 61%), cardiovascular death (HR 0.42; 95% CI 0.21-0.84; P = .014; I 2 = 22%), and HF hospitalization (HR 0.43; 95% CI 0.23-0.82; P = .011; I 2 = 87%). Conclusion: In this meta-analysis, catheter ablation was associated with a lower risk of all-cause death, cardiovascular death, HF hospitalization, and all-cause rehospitalization in comparison to medical therapy in patients with AF and HFpEF. Competing Interests: Disclosures The authors have no conflicts of interest to disclose. (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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