Catheter ablation safe, effective for atrial fibrillation in HFpEF
Patients with HF with preserved ejection fraction who underwent catheter ablation for atrial fibrillation experienced equivalent efficacy to patients without HF, as well as reduced rehospitalization rates vs. medical therapy, data show.
“Studies comparing efficacy between HFpEF and those without HF are necessary to illustrate the universality of catheter ablation in AF patients with HFpEF,” Yizhou Xu, MD, of the department of cardiology at Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, China, and colleagues wrote in the study background. “Moreover, the jury is still out on whether catheter ablation is superior to medical therapy alone in these populations. Recently, certain studies attempted to explore the application of catheter ablation in AF patients with HFpEF and those without HF and compared efficacy between catheter ablation and medical treatment, but the results were inconsistent.”
In a meta-analysis, Xu and colleagues analyzed data from seven studies evaluating catheter ablation for AF in 1,696 patients with HFpEF. Four of the studies compared clinical outcomes after AF ablation in patients with vs. without HFpEF; three studies investigated clinical outcomes of HFpEF patients with AF treated with catheter ablation vs. medical therapy. The mean age of participants ranged from 64 to 75 years; mean follow‐up duration ranged from 12 to 50.9 months and the percentage of men ranged from 44% to 87.2%.
The findings were published in Clinical Cardiology.
Compared with patients without HF, researchers found that the presence of HFpEF did not increase AF ablation procedure time (weighted mean difference, 0.4; 95% CI, 0.01 to 0.81; P = .05) or ablation fluoroscopic time (weighted mean difference, 0.05; 95% CI, 0.18 to 0.28; P = .68). The rate of freedom from AF was similar between patients with HFpEF and without HF (RR = 0.92; 95% CI, 0.76-1.1; P = .34). Additionally, catheter ablation tended to maintain sinus rhythm (RR = 4.73; 95% CI, 1.86-12.03; P = .001) and reduce rehospitalization for HF compared with medical therapy (RR = 0.36; 95% CI, 0.19-0.71; P = .003). There were no between-group differences in mortality (P = .59).
“Catheter ablation is an efficient, safe and effective therapeutic approach for AF patients with HFpEF,” the researchers wrote. “Similar procedure and fluoroscopic time periods were identified regarding the use of catheter ablation for patients with HFpEF and without HF. The success rate of maintaining sinus rhythm in patients with HFpEF was noninferior to those without HF and was significantly better than that of the medical therapy alone group. In addition, catheter ablation can reduce rehospitalization due to HF. However, additional multicenter randomized controlled trials are required to confirm these results.”
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