Introduction
Atrial fibrillation (AF) and severely depressed ejection fraction (SDEF) are two conditions that often coexist. AF increases overall mortality in these patients. The current available guidelines do not provide a clear consensus regarding the best management approach.
We conducted this meta-analysis in order to determine if catheter ablation for AF is superior to medical therapy in this patients
Methods
Data collection: We applied the methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched Pubmed, and the Cochrane Central Register for randomized controlled trials (RCT) that evaluated AF catheter ablation in patients with SDEF (lower than 35%).
Outcome: The primary outcomes were left ventricular ejection fraction (LVEF), 6-minute walk test (6MWT) distance, AF recurrence, and mortality
Statistical Analysis: The analyses were performed using RevMan version 5.3. The results are presented as a mean difference for continuous outcome measures (inverse variance random effect model), and odds ratios (OR) for dichotomous outcomes (Mantel-Haenszel random effect model) with 95% confidence interval (CI).
Results
Four full texts met inclusion criteria. A total of 665 patients were included (324 patients randomized to catheter ablation and 341 patients randomized to medical therapy), with a mean follow-up of 15.2 months.
Arrhythmia recurrence: AF catheter ablation was effective and significantly more patients were in sinus rhythm at the end of the follow-up (OR 14.51 (4.9-42) p < 0.001)
LVEF: compared to medical therapy, AF catheter ablation was associated with a significant increase in LVEF outcome (MD 5.17 (2.06-8.27) p 0.001)
6MWT distance in meters: The mean increase in 6MWT distance was higher in the AF catheter ablation group compared to the medical therapy group (MD 32.7 (13.2-52.3) p 0.001)
All-Cause mortality: the risk of death from any cause was significantly lower in the AF ablation arm (OR…)
Conclusions
Summary evidence from the included RCTs showed that AF catheter ablation significantly increases LVEF, 6MWT distance, sinus rhythm maintenance, and overall mortality.