Heart failure with preserved ejection fraction and atrial fibrillation: catheter ablation vs. standard medical therapy — a systematic review and meta-analysis

IF 4.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Failure Reviews Pub Date : 2024-09-15 DOI:10.1007/s10741-024-10437-3

Mehrdad Mahalleh, Hamidreza Soleimani, Mohammadreza Pazoki, Saba Maleki, Parham Dastjerdi, Pouya Ebrahimi, Sahar Zafarmandi, Sima Shamshiri Khamene, Izat Mohammad Khawajah, Shehroze Tabassum, Rahul Bhardwaj, Jishanth Mattumpuram, Andrew Kaplan, Marmar Vaseghi, Parisa Seilani, Ali Bozorgi, Kaveh Hosseini, Stylianos Tzeis

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引用次数: 0

Abstract

Background

The latest guidelines advocate for catheter ablation (CA) over standard medical therapy (SMT) for managing atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). However, significant knowledge gaps exist regarding the effectiveness of CA vs. SMT in patients with heart failure with preserved ejection fraction (HFpEF).

Methods

PubMed, Scopus, and Embase until February 2024 were systematically searched. Given the limited number of randomized studies, propensity score-matched observational studies comparing CA with SMT in AF patients with HFpEF were also included. The primary outcome was a composite endpoint of all-cause mortality and HF hospitalization.

Results

Eight studies that enrolled 17,717 SMT and 2537 CA patients were included. CA was associated with a significantly lower risk of the composite endpoint of all-cause mortality and HF hospitalization (HR 0.61; 95% CI, 0.43–0.85). The risk of HF hospitalization (HR 0.44; 95% CI, 0.23–0.83), cardiovascular mortality (HR 0.43; 95% CI, 0.22–0.84), and AF recurrence (HR 0.53; 95% CI, 0.39–0.73) were also lower in the CA group.

Conclusion

CA demonstrated significant cardiovascular morbidity and mortality benefits compared to SMT in the HFpEF population.

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射血分数保留型心力衰竭和心房颤动：导管消融与标准药物疗法的比较--系统回顾和荟萃分析

背景最新指南主张，在治疗射血分数降低型心力衰竭（HFrEF）患者的心房颤动（AF）时，采用导管消融术（CA）而非标准药物疗法（SMT）。然而，在射血分数保留型心力衰竭（HFpEF）患者中，CA 与 SMT 的疗效相比还存在很大的知识差距。方法系统检索了截至 2024 年 2 月的 PubMed、Scopus 和 Embase。由于随机研究的数量有限，因此还纳入了倾向评分匹配的观察性研究，对射血分数保留的心力衰竭患者的 CA 与 SMT 进行了比较。主要结果是全因死亡率和心房颤动住院率的复合终点。结果共纳入了 8 项研究，其中包括 17717 名 SMT 患者和 2537 名 CA 患者。CA与全因死亡率和心房颤动住院综合终点风险明显降低相关（HR 0.61；95% CI，0.43-0.85）。CA 组的 HF 住院风险（HR 0.44；95% CI，0.23-0.83）、心血管死亡率（HR 0.43；95% CI，0.22-0.84）和房颤复发风险（HR 0.53；95% CI，0.39-0.73）也较低。

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来源期刊

Heart Failure Reviews 医学-心血管系统

CiteScore

10.40

自引率

2.20%

发文量

审稿时长

6-12 weeks

期刊介绍： Heart Failure Reviews is an international journal which develops links between basic scientists and clinical investigators, creating a unique, interdisciplinary dialogue focused on heart failure, its pathogenesis and treatment. The journal accordingly publishes papers in both basic and clinical research fields. Topics covered include clinical and surgical approaches to therapy, basic pharmacology, biochemistry, molecular biology, pathology, and electrophysiology. The reviews are comprehensive, expanding the reader''s knowledge base and awareness of current research and new findings in this rapidly growing field of cardiovascular medicine. All reviews are thoroughly peer-reviewed before publication.