Catheter Ablation Tops Drug Therapy for A-Fib in Heart Failure

Catheter ablation is better than drug therapy for the treatment of atrial fibrillation (AF) in patients with heart failure, according to a review published online Dec. 25 in the Annals of Internal Medicine.

Mohit K. Turagam, M.D., from Mount Sinai Hospital in New York City, and colleagues performed a meta-analysis to compare the benefits and harms of catheter ablation and drug therapy in adult patients with AF and heart failure. Data were reviewed from six randomized controlled trials with 775 patients.

The researchers observed a reduction in all-cause mortality with AF ablation versus drug therapy (9 versus 17.6 percent; risk ratio, 0.52; 95 percent confidence interval [CI], 0.33 to 0.81) and in heart failure hospitalizations (16.4 versus 27.6 percent; risk ratio, 0.60; 95 percent CI, 0.39 to 0.93). Improvements in left ventricular ejection fraction (LVEF; mean difference, 6.95 percent; 95 percent CI, 3 to 10.9 percent), six-minute walk test distance (mean difference, 20.93 m; 95 percent CI, 5.91 to 35.95 m), peak oxygen consumption (mean difference, 3.17 mL/kg/min; 95 percent CI, 1.26 to 5.07 mL/kg/min), and quality of life (mean difference in Minnesota Living with Heart Failure Questionnaire score, −9.02 points; 95 percent CI, −19.75 to 1.71 points) were seen with ablation. The ablation groups more often had serious adverse events, although differences between the ablation and drug therapy groups were not statistically significant (risk ratio, 1.68; 95 percent confidence interval, 0.58 to 4.85).

"The favorable outcomes reported with catheter ablation probably were driven mostly by a reduction in AF burden and an improvement in LVEF," the authors write.

Several authors disclosed financial ties to the pharmaceutical and medical device industries.

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