Catheter Ablation of Atrial Fibrillation in Patients with Left Ventricular Systolic Dysfunction: A Systematic Review and Meta-Analysis
Background—Catheter ablation of atrial fibrillation (AFCA) is an established therapeutic option for rhythm control in symptomatic patients. Its efficacy and safety among patients with left ventricular systolic dysfunction is based on small populations, and data concerning long-term outcome are limited. We performed this meta-analysis to assess safety and long-term outcome of AFCA in patients with left ventricular systolic dysfunction, to evaluate predictors of recurrence and impact on left ventricular function.
Methods and Results—A systematic review was conducted in MEDLINE/PubMed and Cochrane Library. Randomized controlled trials, clinical trials and observational studies including patients with left ventricular systolic dysfunction undergoing AFCA were included. Twenty-six studies were selected, including 1,838 patients. Mean follow-up was 23 (95% Confidence Interval: 18-40) months. Overall complication rate was 4.2 (3.6-4.8)%. Efficacy in maintaining sinus rhythm at follow-up end was 60 (54-67)%. Meta-regression analysis revealed that time since first AF (p=0.030) and heart failure (p=0.045) diagnosis related to higher, while absence of known structural heart disease (p=0.003) to lower incidence of AF recurrences. Left ventricular ejection fraction improved significantly during follow-up by 13% (p<0.001), with a significant reduction of patients presenting an ejection fraction <35% (p<0.001). NT-proBNP blood levels decreased by 620 pg/ml (p<0.001).
Conclusions—AFCA efficacy in patients with impaired left ventricular systolic function improves when performed early in the natural history of AF and heart failure. AFCA provides long-term benefits on left ventricular function, significantly reducing the number of patients with severely impaired systolic function.
- Received April 29, 2014.
- Revision received September 1, 2014.
- Accepted September 5, 2014.