Catheter ablation versus rate control in patients with atrial fibrillation and heart failure

Abstract

Many trials have shown improvements in left ventricular function, exercise capacity, and quality of life after catheter ablation (CA) of atrial fibrillation (AF) in patients with heart failure (HF). We sought to evaluate the impact of CA on hard outcomes in a retrospective cohort study. AF patients with symptomatic HF from 3 hospitals were included. Our primary endpoint was major adverse cardiac events (MACEs), a composite of all-cause mortality, stroke, and unplanned hospitalization. In total, 90 patients underwent CA and 304 ones received rate control (RaC) were included. After a mean follow-up of 13.5 ± 5.3 months, 82.2% of patients in CA group got freedom from AF; all patients in RaC group remained in AF. CA group had a significant decreased risk of MACEs compared with RaC group (13.3% vs 29.3%, hazard ratio [HR] 0.51, 95% confidence interval [CI]: 0.32–0.82, P = .005). After propensity score matched for confounding factors, difference in MACEs remained significant between groups (13.3% vs 25.6%, HR 0.50, 95% CI: 0.26–0.98, P = .044). Multivariate regression analysis also indicated that CA was significantly associated with a lower risk of MACEs in overall cohort (HR 0.486, 95% CI: 0.253–0.933, P = .030) and in propensity-matched cohort (HR 0.482, 95% CI: 0.235–0.985, P = .045). Besides, age and NYHA class were associated with an increased risk of MACEs. In conclusion, the present study demonstrated that CA for AF in HF patients could reduce the risk of MACEs in a mid-term follow-up. Thus, CA may be a reasonable option for this population.

Action potential shortening rescues atrial calcium alternans

“…; Geng et al . ). In accordance with ongoing clinical efforts to find new, more personalized and less invasive therapeutic approaches, this study explores the role of AP morphology for the development and severity of atrial alternans, and based on these findings, tests the hypothesis that targeted pharmacological modification of AP morphology is a potential therapeutic tool for prevention of arrhythmia.…”

Meta-Analysis of Catheter Ablation versus Medical Therapy for Heart Failure Complicated with Atrial Fibrillation

“…One hundred and six (106) articles were excluded from further screening due to not satisfying the research direction and insufficient data and article type. us, nine (9) studies met the inclusion criteria and were included in the present meta-analysis [18][19][20][21][22][23][24][25][26]. Figure 1 shows the details of the systematic process for our literature search and selection process.…”

Catheter Ablation for Atrial Fibrillation in Systolic Heart Failure Patients: Stone by Stone, a CASTLE

“…These patients are expected to benefit the most from CA procedures and are likely to restore normal or nearnormal LV function. 3,44 Functional Improvement 19 In the recent, randomised CASTLE-AF trial, the composite of any death or hospitalisation for HF worsening was reduced in the CA group (versus optimal medical management) in patients with systolic HF, while total and cardiovascular mortality were also reduced. 33 Finally, the preliminary findings of the Catheter ABlation Versus ANtiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA; NCT00911508) trial were announced in early 2018, but the full results have not been published (the oral presentation slides are available at www.cabanatrial.…”