Abstract 5680: Catheter Ablation in Patients with Atrial Fibrillation and Left Ventricular Systolic Dysfunction: A Meta-Analysis
The efficacy of catheter ablation in patients with atrial fibrillation (AF) and left ventricular systolic dysfunction (LVD) has only been reported in small single center reports. MEDLINE/Pubmed search of studies of ablation in patients with AF and LVD. The primary outcome was maintenance of sinus rhythm. The secondary outcomes were improvement in left ventricular ejection fraction (EF), exercise duration and NYHA functional class. Only 6 studies, enrolling 1063 with AF fulfilled the inclusion criteria. In 4 trials, patients with LVD undergoing ablation were compared to patients with no LVD undergoing ablation. In 2 studies, patients with LVD in the control arm were either medically treated or underwent AV nodal ablation for rate control of AF. For the primary outcome, ablation in patients with LVD had similar success rate (maintenance of sinus rhythm) (RR=0.98; 95% CI=0.93–1.03) compared to patients without LVD. Compared to baseline, ablation in patients with LVD resulted in a strong treatment effect for LVEF (SMD=2.34; 95% CI 1.20 –3.49; 11.8% increase in EF) (Figure⇓), exercise duration (SMD=0.70; 95% CI 0.41– 0.98; 4.9 minutes increase in exercise duration) and NYHA functional class (SMD=1.40; 95% CI 0.51–2.29; 0.7 increase in NYHA class). Ablation of AF patients with LVD results in similar success rate for the maintenance of sinus rhythm as compared to patients without LVD, and results in substantial improvement in ejection fraction, exercise duration and NYHA functional class. Ablation of AF deserves additional study to determine its role in heart failure management.