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Improved Survival in Patients with Atrial Fibrillation and Heart Failure Undergoing Catheter Ablation Compared to Medical Treatment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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  • Jorge Romero,
  • Mohamed Gabr,
  • Isabella Alviz,
  • David Briceno,
  • Juan Carlos Diaz,
  • Daniel Rodriguez,
  • Kavisha Patel,
  • Dalvert Polanco,
  • Chintan Trivedi,
  • Sanghamitra Mohanty,
  • Domenico Della Rocca,
  • Dhanunjaya Lakkireddy,
  • Andrea Natale,
  • Luigi Di Biase
Jorge Romero
Montefiore Medical Center
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Mohamed Gabr
Montefiore Medical Center
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Isabella Alviz
Montefiore Medical Center
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David Briceno
Montefiore Medical Center
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Juan Carlos Diaz
Montefiore Medical Center
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Daniel Rodriguez
Montefiore Medical Center
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Kavisha Patel
Montefiore Medical Center
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Dalvert Polanco
Montefiore Medical Center
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Chintan Trivedi
Saint David's Healthcare
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Sanghamitra Mohanty
Saint David's Healthcare
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Domenico Della Rocca
Saint David's Healthcare
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Dhanunjaya Lakkireddy
HCA Midwest Health System
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Andrea Natale
Saint David's Healthcare
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Luigi Di Biase
Montefiore Medical Center
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Abstract

Introduction: Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) patients with heart failure (HF) undergoing catheter ablation (CA) as compared to medical therapy. We sought to investigate the benefit of CA on outcomes of patients with AF and HF as compared to medical therapy. Methods and Results: A systematic review of PubMed, Embase, and Cochrane Central Register of Clinical Trials was performed for clinical studies evaluating the benefit of CA for patients with AF and HF. Primary endpoint was all-cause mortality. Secondary endpoints included atrial-arrhythmia recurrence and improvement in left ventricular ejection fraction (LVEF). Eight randomized controlled trials were included with a total of 2121 patients (mean age: 65 ± 5 years; 72% male). Mean follow-up duration was 32.9 ± 14.5 months. All-cause mortality in patients who underwent CA was significantly lower than in the medical treatment group (8.8% vs. 13.5%, RR 0.65, 95% CI 0.51-0.83, P=0.0005). A 35% relative risk reduction and 4.7% absolute risk reduction in all-cause mortality was observed with CA. Rates of atrial-arrhythmia recurrence were significantly lower in the CA group (39.9% vs 69.6%, RR 0.55, 95% CI 0.40-0.76, P=0.0003). Improvement in LVEF was significantly higher in patients undergoing CA (+9.4 ±7.6%) as compared to conventional treatment (+3.3±8%) (Mean difference 6.2, 95% CI 3.6-8.8, P<0.00001). Conclusion: CA for AF in patients with HF decreases all-cause mortality, improves atrial-arrhythmia recurrence rate and LVEF when compared to medical management. CA should be considered the treatment of choice to improve survival in this select group of patients.
06 Jun 2022Submitted to Journal of Cardiovascular Electrophysiology
06 Jun 2022Submission Checks Completed
06 Jun 2022Assigned to Editor
10 Jun 2022Reviewer(s) Assigned
30 Jun 2022Review(s) Completed, Editorial Evaluation Pending
04 Jul 2022Editorial Decision: Revise Minor
08 Jul 20221st Revision Received
08 Jul 2022Submission Checks Completed
08 Jul 2022Assigned to Editor
08 Jul 2022Reviewer(s) Assigned
08 Jul 2022Review(s) Completed, Editorial Evaluation Pending
09 Jul 2022Editorial Decision: Accept
16 Jul 2022Published in Journal of Cardiovascular Electrophysiology. 10.1111/jce.15622