Catheter ablation for atrial fibrillation and impact on clinical outcomes

Abstract

Catheter ablation is the most effective rhythm-control option in patients with atrial fibrillation (AF) and is currently considered and option mainly for improving symptoms. We aimed to assess the impact of catheter ablation on hard clinical outcomes. We performed a systematic review of randomized controlled trials comparing catheter ablation vs. optimized medical treatment. We searched MEDLINE, EMBASE and CENTRAL on January 8th, 2024, for trials published ≤10 years. We pooled data risk ratio (RR) & mean differences (MD), with 95% confidence interval (CI), and calculated the Number Needed to Treat (NNT). Sub-group and sensitivity analyses were performed for presence/absence of heart failure (HF), paroxysmal/persistent AF, early ablation, higher/lower quality, and published ≤5 vs >5 years. Twenty-two randomized controlled trials were identified, including 6,400 patients followed for 6 to 52 months. All primary endpoints were significantly reduced by catheter ablation vs. medical management: all-cause hospitalization (RR=0.57, 95%CI 0.39-0.85, P=0.006), AF relapse (RR=0.48, 95%CI 0.39-0.58, P<0.00001), all-cause mortality (RR=0.69, 95%CI 0.56-0.86, P=0.0007, NNT=44.7) driven trials with HF patients. A benefit was also demonstrated for all secondary endpoints: cardiovascular mortality (RR=0.55, 95%CI 0.34-0.87), cardiovascular (RR=0.83, 95%CI 0.71-0.96) and HF hospitalizations (RR=0.71, 95%CI 0.56-0.89), AF burden (MD=20.6%, 95%CI 5.6-35.5), LVEF recovery (MD=5.7%, 95%CI 3.5-7.9) and quality of life (MLHFQ, AFEQT & SF-36 scales). Catheter ablation significantly reduced hospitalizations, AF burden and relapse, and improved quality of life. An impact on hard clinical outcomes, with an important mortality reduction and improvement in LVEF, was seen for patients with AF and HF.