Catheter ablation of atrial fibrillation in heart failure with impaired systolic function - An updated meta-analysis of randomized controlled trials

Q: What is the study’s main objective?

To evaluate whether radiofrequency catheter ablation (RFCA) improves outcomes compared with medical therapy in heart failure patients with atrial fibrillation and impaired systolic function.

Q: What were the key findings comparing RFCA with medical therapy?

RFCA showed significantly lower all-cause mortality, heart failure hospitalization, and AF recurrence, along with higher VO2max, improved quality of life, and better LVEF.

Q: Did RFCA reduce all-cause mortality in all patient subgroups?

No. In a specific meta-analysis of four RCTs including patients with LVEF ≤35%, RFCA failed to reduce all-cause mortality, suggesting stratification by baseline LVEF is necessary.

Sep 29, 2026

Uploaded by Aria Callaghan

Background: The Atrial Fibrillation Management in Congestive Heart Failure With Ablation trial showed no benefit of catheter ablation in patients with atrial fibrillation, advanced heart failure, and severely reduced left ventricular ejection fraction (LVEF). This meta-analysis hypothesized that radiofrequency catheter ablation (RFCA) could improve outcomes in heart failure patients with atrial fibrillation and impaired left ventricular systolic function (LVEF <50%) versus medical therapy. Methods: Randomized controlled trials comparing RFCA with medical therapy were searched and pooled. Results: RFCA reduced all-cause mortality, heart failure hospitalization, and AF recurrence, while improving VO2max, quality of life, and LVEF. Conclusion: RFCA benefits clinical, structural, functional, and quality-of-life outcomes, but did not reduce all-cause mortality in patients with LVEF ≤35%, indicating the need for patient stratification.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Methods

Data sources

Selection criteria and data extraction

Outcomes

J Chin MedAssoc Original article Catheter ablation of atrial fibrillation in heart failure with impaired systolic function: An updated meta-analysis of randomized controlled trials Ting-Yung Changa,b,c,d, Tze-Fan Chaoa,b,c,*, Chin-Yu Lina,b,c, Yenn-Jiang Lina,b,c, Shih-Lin Changa,b,c, Li-Wei Loa,b,c, Yu-Feng Hua,b,c, Fa-Po Chunga,b,c, Shih-Ann Chena,b,c,e aDivision of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bDivision of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cInstitute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; dNational Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC; eCardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC Abstract Background: The recent Atrial Fibrillation Management in Congestive Heart Failure With Ablation trial did not reveal any benefit of catheter ablation in patients with atrial fibrillation (AF), advanced heart failure (HF), and severely reduced left ventricular ejection fraction (LVEF) . We hypothesized that radiofrequency catheter ablation (RFCA) could improve outcomes in HF patients with AF and impaired left ventricular systolic function (LVEF <50%) as compared with only medical therapy. Methods: We searched the literature for randomized clinical trials (RCTs) that compared RFCAto medical therapy in this population. Results: Compared with the medical therapy group, the RFCA group had significantly less all-cause mortality, HF hospitalization, and AF recurrence rates. The RFCA group had significantly higher peak oxygen consumption (VO2max), a better quality of life (Minnesota Living with Heart Failure Questionnaire score), and improved LVEF. However, RFCA for AF failed to reduce all-cause mortality in a specific meta-analysis of four RCTs that enrolled patients with LVEF ≤35% . Conclusion: Compared with medical therapy, RFCA for AF in the setting of HF with impaired systolic function is associated with better clinical (HF hospitalization and all-cause mortality), structural (LVEF improvement), functional (VO2max), and quality of life outcomes. However, RFCA for AF failed to reduce all-cause mortality in RCTs that enrolled patients with LVEF ≤35% and thereby indicated the necessary stratification to identify patients who may benefit more from RFCA. Keywords: Ablation; Heart failure; Outcomes; Meta-analysis 1. INTRODUCTION Atrial fibrillation (AF) and heart failure (HF) often coexist. Approximately half of HF patients have AF, which can lead to tachycardia-induced cardiomyopathy.1 The coexistence of AF and HF is associated with increased morbidity, mortality, and healthcare costs,2,3 and the restoration and maintenance of sinus rhythm in HF patients with AF could alleviate symptoms.4 In the last two decades, radiofrequency catheter ablation (RFCA) has become a treatment for AF.5 A meta-analysis of randomized control trials (RCTs) compared the efficacy and *Address correspondence. Dr. Tze-Fan Chao, Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail: eyckeyck@gmail.com](ROC. E-mail: eyckeyck@gmail.com) (T.-F. Chao) Conflicts of interest: Dr. Shih-Ann Chen, an editorial board member at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 11-18. Received June 14, 2022; accepted September 2, 2022. doi: 10. 1097/JCMA.0000000000000823. Copyright © 2022, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/lice

FAQs

What is the study’s main objective?

To evaluate whether radiofrequency catheter ablation (RFCA) improves outcomes compared with medical therapy in heart failure patients with atrial fibrillation and impaired systolic function.

What were the key findings comparing RFCA with medical therapy?

RFCA showed significantly lower all-cause mortality, heart failure hospitalization, and AF recurrence, along with higher VO2max, improved quality of life, and better LVEF.

Did RFCA reduce all-cause mortality in all patient subgroups?

No. In a specific meta-analysis of four RCTs including patients with LVEF ≤35%, RFCA failed to reduce all-cause mortality, suggesting stratification by baseline LVEF is necessary.

Sep 29, 2026

Uploaded by Aria Callaghan