Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure

Electrophysiological interventions in the treatment of chronic heart failure: a comparison of the strength of evidence supporting cardiac resynchronization for electrical conduction delay and catheter ablation for atrial fibrillation

“…Two other trials did not observe significant increases in ejection fraction with the pre‐specified imaging methods of primary interest. The meta‐analyses also reported nominally significant decreases in the risk of death or hospitalization for heart failure, but these results were driven almost entirely by the findings of one trial that had significant shortcomings in randomization, in the integrity of follow‐up and in the completeness of the intention‐to‐treat analyses . Despite favourable conclusions by the authors, the findings of the meta‐analyses are fragile and inconclusive.…”

“…Despite the heterogeneity of the designs and sparseness of the data, the six trials have been combined in numerous meta‐analyses . The most recent of these studies noted an increase in left ventricular ejection fraction across the trials, but with significant heterogeneity, thus undermining the assumptions that would allow pooling of results. Measurements were largely made by echocardiography, which is an unreliable method in patients with atrial fibrillation.…”

Long-term Outcome of Pulmonary Vein Isolation Versus Amiodarone Therapy in Patients with Coexistent Persistent AF and Congestive Heart Failure

“…13 These guidelines are based on a handful of trials overall showing improved LVEF and long-term clinical outcomes with catheter ablation of AF in HFrEF patients compared with sole rate or rhythm control. 8 These results are somewhat unsurprising, given that AF is the most common cause of tachyarrhythmia-induced cardiomyopathy, and that even short runs of tachycardic AF can trigger an acute decompensation in patients with an already compromised systolic function. 14 In the long run, persistent AF can chronically worsen LVEF, a phenomenon that seems to occur even with normal heart rates, likely due to asynchrony and irregular heart rhythm.…”

Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP‐AF risk scoring systems

“…Atrial fibrillation (AF) and heart failure (HF) frequently coexist due to shared risk factors and pathophysiology. Catheter ablation of AF in patients with HF improves quality of life, left ventricular ejection fraction, and survival compared to pharmacologic rhythm control . Despite its benefits, catheter ablation is an invasive procedure with a small, but measurable risk of major adverse events.…”