Meta-Analysis of Atrial Fibrillation Ablation in Patients with Systolic Heart Failure

Mohammed Ruzieh, Andrew J. Foy, Nader M. Aboujamous, Morgan K. Moroi, Gerald V. Naccarelli, Mehrdad Ghahramani, Shaffi Kanjwal, Joseph E. Marine, Khalil Kanjwal

Research output: Contribution to journalReview article

Abstract

Atrial fibrillation (AF) and heart failure (HF) are two common conditions that often coexist and predispose each to one another. AF increases hospitalization rates and overall mortality in patients with HF. The current available therapeutic options for AF in patients with HF are diverse and guidelines do not provide a clear consensus regarding the best management approach. To determine if catheter ablation for AF is superior to medical therapy alone in patients with coexisting HF, we conducted this systematic review and meta-analysis. The primary outcomes evaluated are left ventricular ejection fraction (LVEF), Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores, 6-minute walk test (6MWT) distance, heart failure hospitalizations, and mortality. The results are presented as a mean difference for continuous outcome measures and odds ratios for dichotomous outcomes (using Mantel-Haenszel random effects model). 7 full texts met inclusion criteria, including 856 patients. AF catheter ablation was associated with a significant increase in LVEF (mean difference 6.8%; 95% CI: 3.5-10.1; P<0.001) and 6MWT (mean difference 29.3; 95% CI: 11.8-46.8; P = 0.001), and improvement in MLWHFQ (mean difference-12.1; 95% CI:-20.9-3.3; P = 0.007). The risk of all-cause mortality was significantly lower in the AF ablation arm (OR 0.49; 95% CI: 0.31-0.77; P = 0.002). In conclusion, atrial fibrillation ablation in patients with systolic heart failure is associated with significant improvement in LVEF, quality of life, 6MWT, and overall mortality.

Original languageEnglish (US)
Article number8181657
JournalCardiovascular Therapeutics
Volume2019
DOIs
StatePublished - Jan 1 2019

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Systolic Heart Failure
Atrial Fibrillation
Meta-Analysis
Heart Failure
Stroke Volume
Catheter Ablation
Mortality
Hospitalization
Odds Ratio
Quality of Life
Outcome Assessment (Health Care)
Guidelines
Therapeutics

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Ruzieh, Mohammed ; Foy, Andrew J. ; Aboujamous, Nader M. ; Moroi, Morgan K. ; Naccarelli, Gerald V. ; Ghahramani, Mehrdad ; Kanjwal, Shaffi ; Marine, Joseph E. ; Kanjwal, Khalil. / Meta-Analysis of Atrial Fibrillation Ablation in Patients with Systolic Heart Failure. In: Cardiovascular Therapeutics. 2019 ; Vol. 2019.
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title = "Meta-Analysis of Atrial Fibrillation Ablation in Patients with Systolic Heart Failure",
abstract = "Atrial fibrillation (AF) and heart failure (HF) are two common conditions that often coexist and predispose each to one another. AF increases hospitalization rates and overall mortality in patients with HF. The current available therapeutic options for AF in patients with HF are diverse and guidelines do not provide a clear consensus regarding the best management approach. To determine if catheter ablation for AF is superior to medical therapy alone in patients with coexisting HF, we conducted this systematic review and meta-analysis. The primary outcomes evaluated are left ventricular ejection fraction (LVEF), Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores, 6-minute walk test (6MWT) distance, heart failure hospitalizations, and mortality. The results are presented as a mean difference for continuous outcome measures and odds ratios for dichotomous outcomes (using Mantel-Haenszel random effects model). 7 full texts met inclusion criteria, including 856 patients. AF catheter ablation was associated with a significant increase in LVEF (mean difference 6.8{\%}; 95{\%} CI: 3.5-10.1; P<0.001) and 6MWT (mean difference 29.3; 95{\%} CI: 11.8-46.8; P = 0.001), and improvement in MLWHFQ (mean difference-12.1; 95{\%} CI:-20.9-3.3; P = 0.007). The risk of all-cause mortality was significantly lower in the AF ablation arm (OR 0.49; 95{\%} CI: 0.31-0.77; P = 0.002). In conclusion, atrial fibrillation ablation in patients with systolic heart failure is associated with significant improvement in LVEF, quality of life, 6MWT, and overall mortality.",
author = "Mohammed Ruzieh and Foy, {Andrew J.} and Aboujamous, {Nader M.} and Moroi, {Morgan K.} and Naccarelli, {Gerald V.} and Mehrdad Ghahramani and Shaffi Kanjwal and Marine, {Joseph E.} and Khalil Kanjwal",
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Ruzieh, M, Foy, AJ, Aboujamous, NM, Moroi, MK, Naccarelli, GV, Ghahramani, M, Kanjwal, S, Marine, JE & Kanjwal, K 2019, 'Meta-Analysis of Atrial Fibrillation Ablation in Patients with Systolic Heart Failure', Cardiovascular Therapeutics, vol. 2019, 8181657. https://doi.org/10.1155/2019/8181657

Meta-Analysis of Atrial Fibrillation Ablation in Patients with Systolic Heart Failure. / Ruzieh, Mohammed; Foy, Andrew J.; Aboujamous, Nader M.; Moroi, Morgan K.; Naccarelli, Gerald V.; Ghahramani, Mehrdad; Kanjwal, Shaffi; Marine, Joseph E.; Kanjwal, Khalil.

In: Cardiovascular Therapeutics, Vol. 2019, 8181657, 01.01.2019.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Meta-Analysis of Atrial Fibrillation Ablation in Patients with Systolic Heart Failure

AU - Ruzieh, Mohammed

AU - Foy, Andrew J.

AU - Aboujamous, Nader M.

AU - Moroi, Morgan K.

AU - Naccarelli, Gerald V.

AU - Ghahramani, Mehrdad

AU - Kanjwal, Shaffi

AU - Marine, Joseph E.

AU - Kanjwal, Khalil

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Atrial fibrillation (AF) and heart failure (HF) are two common conditions that often coexist and predispose each to one another. AF increases hospitalization rates and overall mortality in patients with HF. The current available therapeutic options for AF in patients with HF are diverse and guidelines do not provide a clear consensus regarding the best management approach. To determine if catheter ablation for AF is superior to medical therapy alone in patients with coexisting HF, we conducted this systematic review and meta-analysis. The primary outcomes evaluated are left ventricular ejection fraction (LVEF), Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores, 6-minute walk test (6MWT) distance, heart failure hospitalizations, and mortality. The results are presented as a mean difference for continuous outcome measures and odds ratios for dichotomous outcomes (using Mantel-Haenszel random effects model). 7 full texts met inclusion criteria, including 856 patients. AF catheter ablation was associated with a significant increase in LVEF (mean difference 6.8%; 95% CI: 3.5-10.1; P<0.001) and 6MWT (mean difference 29.3; 95% CI: 11.8-46.8; P = 0.001), and improvement in MLWHFQ (mean difference-12.1; 95% CI:-20.9-3.3; P = 0.007). The risk of all-cause mortality was significantly lower in the AF ablation arm (OR 0.49; 95% CI: 0.31-0.77; P = 0.002). In conclusion, atrial fibrillation ablation in patients with systolic heart failure is associated with significant improvement in LVEF, quality of life, 6MWT, and overall mortality.

AB - Atrial fibrillation (AF) and heart failure (HF) are two common conditions that often coexist and predispose each to one another. AF increases hospitalization rates and overall mortality in patients with HF. The current available therapeutic options for AF in patients with HF are diverse and guidelines do not provide a clear consensus regarding the best management approach. To determine if catheter ablation for AF is superior to medical therapy alone in patients with coexisting HF, we conducted this systematic review and meta-analysis. The primary outcomes evaluated are left ventricular ejection fraction (LVEF), Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores, 6-minute walk test (6MWT) distance, heart failure hospitalizations, and mortality. The results are presented as a mean difference for continuous outcome measures and odds ratios for dichotomous outcomes (using Mantel-Haenszel random effects model). 7 full texts met inclusion criteria, including 856 patients. AF catheter ablation was associated with a significant increase in LVEF (mean difference 6.8%; 95% CI: 3.5-10.1; P<0.001) and 6MWT (mean difference 29.3; 95% CI: 11.8-46.8; P = 0.001), and improvement in MLWHFQ (mean difference-12.1; 95% CI:-20.9-3.3; P = 0.007). The risk of all-cause mortality was significantly lower in the AF ablation arm (OR 0.49; 95% CI: 0.31-0.77; P = 0.002). In conclusion, atrial fibrillation ablation in patients with systolic heart failure is associated with significant improvement in LVEF, quality of life, 6MWT, and overall mortality.

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U2 - 10.1155/2019/8181657

DO - 10.1155/2019/8181657

M3 - Review article

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JF - Cardiovascular Therapeutics

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