Short-term Heart Function Change of Catheter Ablation in Persistent Atrial Fibrillation and Heart Failure: A Meta-analysis of Randomized Controlled Trials

Background: The effect of catheter ablation (CA) versus drug therapy on cardiac function improvement is not clear for patients with persistent atrial fibrillation and heart failure. To compare the short-term therapeutic effects between CA and conventional drug therapy, we conducted a meta-analysis of the current randomized controlled trials (RCTs). Objective and method: The analyses systematically collected PubMed, Embase, and the Cochrane Library for RCTs comparing catheter ablation with medical therapy in patients with persistent atrial fibrillation and heart failure. In order to reduce the impact of other factors on cardiac function, we limited the maximum follow-up time to two years. The primary outcome is changes in left ventricular ejection fraction (LEVF), second outcomes are changes in 6-minute walk test (6MWT), Minnesota Living with Heart Failure Score (MLHFQ), B-type natriuretic peptide (BNP). SMD was used for the results measured by different methods. Random-effects model or fixed-effects model was used to estimate relative risks (RRs) with 95% confidence intervals (CIs). Results: A total of six randomized controlled trials included 775 patients included in the final analysis, compared with drug therapy, catheter ablation has a better improvement in left ventricular ejection fraction (SMD, 0.57; 95% CI [0.40, 0.94], p<0.00001), 6-minute walk distance(MD 23.35, 95% CI [5.51, 41.19], p<0.00001), Minnesota Living with Heart Failure Score (MD -11.13, 95% CI [-2.52, -19.75], p=0.01), and B-type natriuretic peptide (110.93, 95% CI [82.84, 139.3], p<0.00001). Conclusion: Catheter ablation has a better improvement than medical treatment in heart function for patients with persistent atrial fibrillation and heart failure.