Comparison of catheter ablation and medical therapy for atrial fibrillation in heart failure patients: A meta-analysis of randomized controlled trials

Şaylık, Faysal; Çınar, Tufan; Akbulut, Tayyar; Hayıroğlu, Mert İlker

doi:10.1016/j.hrtlng.2022.08.012

Cited by 26 publications

(29 citation statements)

References 21 publications

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“…The impact of atrial fibrillation ablation on LA and LV reverse remodeling and prognosis [ 27 ] has not been established in our study but might deserve specific analysis in this particular population of patients.…”

Section: Discussionmentioning

confidence: 99%

Acute and Chronic Changes in Myocardial Work Parameters in Patients with Severe Primary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair

Galli

Hubert

Leurent

et al. 2023

JCDD

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Background: The noninvasive assessment of myocardial work (MW) allows for the evaluation of left ventricular (LV) performance by considering the effect of LV afterload. This study aims to evaluate the acute and chronic impact of transcatheter edge-to-edge repair (TEER) on MW parameters and LV remodeling in patients with severe primary mitral regurgitation (PMR). Methods: A total of 71 patients (age: 77 ± 9 years, females: 44%) with moderate–to-severe or severe PMR (effective regurgitant orifice: 0.57 ± 0.31 cm2; regurgitant volume: 80 ± 34 mL; LV end-systolic diameter: 42 ± 12 mm) underwent TEER after a global assessment by the heart team. MW indices were evaluated before the procedure, at hospital discharge, and at 1-year follow-up. LV remodeling was described as the percentage variation in LVEDV between baseline and 1-year follow-up. Results: TEER caused an acute reduction in LVEF, global longitudinal strain (GLS), global MW index (GWI), work efficiency (GWE), and mechanical dispersion (MD) and a significant increase in wasted work (GWW). One year after the procedure, GLS, GWI, GWE, and MD recovered, whereas GWW remained significantly impaired. Baseline GWW (β = −0.29, p = 0.03) was an independent predictor of LV reverse remodeling at 1-year follow-up. Conclusions: In patients with severe PMR undergoing TEER, the acute reduction in LV preload causes significant impairment to all the parameters of LV performance. Baseline GWW was the only independent predictor of LV reverse remodeling, suggesting that a lower myocardial energetic efficiency in the context of chronic preload increase might impact the left ventricular response to mitral regurgitation correction.

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Section: Discussionmentioning

confidence: 99%

Acute and Chronic Changes in Myocardial Work Parameters in Patients with Severe Primary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair

Galli

Hubert

Leurent

et al. 2023

JCDD

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“…Numerous random clinical trials and meta-analyses have investigated the initial choice of radiofrequency ablation or drug therapy for newly diagnosed atrial fibrillation with an average age above 60 years [ 2 , 3 ]. Results of these studies showed that radiofrequency ablation is superior to antiarrhythmic drug therapy, for not only reducing all-cause rehospitalization but also improving the long-term quality of life for patients [ 19 ]. Our study focused on outcomes of RFCA in AF patients younger than 45 years.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Predictors of Late Recurrence in Young Patients with Atrial Fibrillation after Catheter Ablation

Chen

Zhang

et al. 2023

Computational and Mathematical Methods in Medicine

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Background. Catheter ablation (CA) is an established treatment for atrial fibrillation (AF), but the recurrence of AF is not neglected. Young patients with AF were generally more symptomatic and intolerant to long-term drug treatment. We aim to explore clinical outcomes and predictors of late recurrence (LR) in AF patients younger than 45 years after CA to better manage them. Methods. We retrospectively studied 92 symptomatic AF patients who accepted CA from September 1, 2019, to August 31, 2021. Baseline clinical data (including N-terminal prohormone of brain natriuretic peptide, NT-proBNP), ablation outcomes, and follow-up outcomes were collected. Patients were followed up at 3, 6, 9, and 12 months. Follow-up data were available for 82/92 (89.1%) patients. Results. One-year arrhythmia-free survival was 81.7% (67/82) in our study group. Major complications occurred in 3/82 (3.7%) patients with an acceptable rate. The value of ln(NT-proBNP) ( P = 0.025 , odds ratio OR = 1.977 , 95% confidence interval [CI] 1.087-3.596) and a family history of AF ( P = 0.041 , HR = 9.269 , 95% CI 1.097-78.295) could independently predict AF recurrence. The ROC analysis of ln(NT-proBNP) showed that NT-proBNP greater than 200.05 pg/ml (area under the curve: 0.772, 95% CI 0.642-0.902, P = 0.001 , sensitivity 0.800, specificity 0.701) was the cut-off point for predicting late recurrence. Conclusions. CA is a safe and effective treatment for AF patients younger than 45 years. Elevated NT-proBNP level and a family history of AF could be used as predictors for late recurrence in young patients. The result of this study may help us take more comprehensive management of those with high-recurrence risks to reduce disease burden and improve quality of life.

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“…Meta-analysis revealed that electrical cardioversion and antiarrhythmic drugs had similar all-cause mortality compared with medical rate therapy 15. On the other hand, meta-analysis showed that catheter ablation was superior to pharmacological rate and rhythm therapy in all-cause mortality and improvements in quality of life 16. However, due to the small sample size of these randomised trials, current guidelines only suggest catheter ablation with moderate (Class IIa, level B) recommendations 1 2 17.…”

Section: Discussionmentioning

confidence: 99%

In-hospital therapies and determinants of treatment strategy selection in patients with atrial fibrillation and left ventricular systolic dysfunction in China: a retrospective study based on the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project, 2015–2019

Pan

Jiang

et al. 2023

BMJ Open

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ObjectivesThe optimal treatment strategy remains debatable in patients with atrial fibrillation (AF) and heart failure. Our objectives were to summarise in-hospital therapies and determine factors associated with treatment strategy selections.DesignA retrospective study analysing the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project from 2015 to 2019.SettingThe CCC-AF project included patients from 151 tertiary and 85 secondary hospitals across 30 provinces in China.ParticipantsPatients with AF and left ventricular systolic dysfunction (LVSD, defined as left ventricular ejection fraction<50%) were included, with 5560 patients in the study sample.MethodsPatients were classified by treatment strategies. In-hospital treatments and trends of therapies were analysed. Multiple logistic regression models were used to find determinants of treatment strategies.ResultsRhythm control therapies were used in 16.9% of patients with no significant trends (ptrend=0.175). Catheter ablation was used in 5.5% of patients, increasing from 3.3% in 2015 to 6.6% in 2019 (ptrend<0.001). Factors negatively associated with rhythm control included increased age (OR 0.973, 95% CI 0.967 to 0.980), valvular AF (OR 0.618, 95% CI 0.419 to 0.911), AF types (persistent: OR 0.546, 95% CI 0.462 to 0.645; long-standing persistent: OR 0.298, 95% CI 0.240 to 0.368), larger left atrial diameters (OR 0.966, 95% CI 0.957 to 0.976) and higher Charlson Comorbidity Index scores (CCI 1–2: OR 0.630, 95% CI 0.529 to 0.750; CCI≥3: OR 0.551, 95% CI 0.390 to 0.778). Higher platelet counts (OR 1.025, 95% CI 1.013 to 1.037) and prior rhythm control attempts (electrical cardioversion: OR 4.483, 95% CI 2.369 to 8.483; catheter ablation: OR 4.957, 95% CI 3.072 to 7.997) were positively associated with rhythm control strategies.ConclusionIn China, non-rhythm control strategy remained the dominant choice in patients with AF and LVSD. Age, AF types, prior treatments, left atrial diameters, platelet counts and comorbidities were major determinants of treatment strategies. Guideline-adherent therapies should be further promoted.Study registration numberNCT02309398.

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Comparison of catheter ablation and medical therapy for atrial fibrillation in heart failure patients: A meta-analysis of randomized controlled trials

Cited by 26 publications

References 21 publications

Acute and Chronic Changes in Myocardial Work Parameters in Patients with Severe Primary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair

Acute and Chronic Changes in Myocardial Work Parameters in Patients with Severe Primary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair

Clinical Outcomes and Predictors of Late Recurrence in Young Patients with Atrial Fibrillation after Catheter Ablation

In-hospital therapies and determinants of treatment strategy selection in patients with atrial fibrillation and left ventricular systolic dysfunction in China: a retrospective study based on the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project, 2015–2019

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