By Will Boggs MD
NEW YORK (Reuters Health) - 1/8/2019
Catheter ablation improves survival, quality of life and other outcomes in patients with atrial fibrillation (AF) complicated with heart failure (HF), according to a pooled analysis of randomized trials.
"Catheter ablation should be considered as the first-line therapy for atrial fibrillation complicated with heart failure," Dr. Shaojie Chen of Cardiovascular Center Bethanien, in Frankfurt am Main, Germany, told Reuters Health by email. "Of course, future studies are still warranted to further optimize patient selection for catheter ablation."
Previous studies have established the functional improvements associated with catheter ablation in AF patients complicated with HF, but few randomized trials have reported hard endpoints like survival.
Dr. Chen and colleagues pooled data from nearly 3,600 patients with AF complicated with HF that participated in 11 randomized trials to evaluate the impact of rhythm control strategies using either antiarrhythmic drugs or catheter ablation.
In the subset of studies that compared medical rhythm control versus rate control, medical rhythm control was associated with significantly higher rates of rehospitalization (59.3% vs. 54.4%) but similar rates of all-cause mortality (26.4% vs. 27.3%, respectively) and stroke and thromboembolic events (3.6% vs. 4%).
In the subset of studies that compared catheter-ablation rhythm control versus medical rhythm control, catheter ablation was associated with significantly lower all-cause mortality (10.7% vs. 18.9% for medical control), significantly lower rehospitalization rates (30.6% vs. 47.5%) and a non-significant difference in stroke events (2.8% vs. 4.7%).
In this comparison, patients in the catheter-ablation rhythm control group also had significantly greater improvement in left ventricular ejection fraction (LVEF), significantly less recurrence of AF/atrial tachycardia (29.6% vs. 80.1%) and significantly greater improvement in quality of life scores.
The rate of overall composite adverse events was nominally lower with catheter ablation (22.8%) than with medical therapy (34%), but this difference fell short of statistical significance, the researchers report in the European Heart Journal, online July 11.
There were no procedure-related deaths, and the rates of other procedure-related adverse events were low (tamponade, 1.3%; groin complications, 1.3%; and pulmonary vein stenosis, 0.3%).
"Catheter ablation as a rhythm-control strategy not only significantly improves patients' functional outcome and quality of life, but also substantially improves patients' clinical hard endpoints (all-cause mortality, re-hospitalization) as compared with medical therapy, suggesting that catheter ablation is a cost-effective therapeutic treatment for this patient population," Dr. Chen concluded.
Eur Heart J 2019.