Long-term effects of catheter ablation vs medical therapy in patients with atrial fibrillation and heart failure: A reconstructed individual patient data meta-analysis.
Eduardo Dan Itaya, Felipe Aranha, Lucas M Barbosa et al.
✦ AI-curated · Sources linked
In 30 seconds
This meta-analysis assessed long-term outcomes of catheter ablation (CA) versus medical therapy (MT) in patients with atrial fibrillation and heart failure. It included seven randomized controlled trials with 2,117 patients and follow-up ranging from 2 to 7.8 years; individual time-to-event data were reconstructed from published Kaplan-Meier curves. Compared with MT, CA was associated with lower all-cause mortality (odds ratio 0.55; 95% CI 0.42-0.71; P < .01), fewer heart-failure events, and improved left ventricular ejection fraction. Reconstructed analyses also found lower mortality and hospitalization risks.
Key findings
- CA was associated with lower all-cause mortality than MT (odds ratio 0.55; 95% CI 0.42-0.71; P < .01).
- Heart-failure events were reduced with CA (odds ratio 0.51; 95% CI 0.33-0.77; P < .01).
- CA improved left ventricular ejection fraction by a mean difference of 6.23%; 95% CI 3.31-9.14; P < .00001.
- Reconstructed individual patient data analyses found lower mortality (HR 0.59) and fewer HF hospitalizations (HR 0.56) with CA.
Why it matters
Atrial fibrillation and heart failure commonly coexist, and this analysis suggests that the benefits of catheter ablation over medical therapy may extend to long-term outcomes, including mortality and heart-failure events. The findings also indicate improvement in ventricular function and rhythm outcomes, helping frame ablation as a potential option for this high-risk population while recognizing that the estimates derive from pooled trial evidence.
What to keep in mind
Individual time-to-event data were reconstructed from published Kaplan-Meier curves rather than obtained as original patient-level data.