Abstract 18172: Rhythm Control with Catheter Ablation Improves Ejection Fraction Compared to Rate Control: A Meta-Analysis of Randomized Controlled Studies
Background: Atrial fibrillation (AF) can exacerbate/worsen heart failure. A randomized study showed that rhythm control with anti-arrhythmic drugs (AADs) is not superior to rate control for heart failure patients who develop AF. However, a recent study revealed catheter ablation can improve the ejection fraction (EF) compared to medical rate control.
Hypothesis: We performed a meta-analysis to compare the effect of rhythm control and medical rate control on EF in heart failure patients with AF.
Methods: We searched PubMed, Embase, Google Scholar and Cochrane databases for all randomized controlled trials (RCTs) comparing rhythm control versus rate control for AF in heart failure. Primary outcome was change in EF. Random effects model was used to pool and analyze data across the studies.
Results: Of a total of 7 RCTs (4 - AADs, 3 - catheter ablation) which compared rhythm control and medical rate control, 4 studies (n=202) reported quantitative data on EF. There was significant heterogeneity between the studies (I2=82%, p <0.001). Compared to rate control, the mean improvement in EF with rhythm control was 5.94% (95% CI 0.63- 11.26, p=0.03). Sub-group analysis revealed catheter ablation improved the EF by 6.67% (95% CI 0.23 -13.11, p=0.04) whereas rhythm control with AADs did not significantly change EF (3.50, -1.76 -8.76).
Conclusion: Rhythm control is associated with greater improvement in EF compared to rate control therapy in heart failure patients with AF. Catheter ablation of AF significantly improves the EF in these patients. Further studies are needed to determine if this improvement in EF is associated with decreased morbidity and mortality.
Author Disclosures: A. Vallakati: None. A. Kanmantha Reddy: None. M. Dunlap: None. W. Lewis: None.
- © 2014 by American Heart Association, Inc.