Comparison of catheter ablation and medical therapy for atrial fibrillation in heart failure patients: A meta-analysis of randomized controlled trials

Background The results of studies comparing the outcomes of catheter ablation (CA) to those of medical therapy (MT) for atrial fibrillation (AF) in heart failure (HF) patients are contradictory. Objectives Our objective was to conduct a meta-analysis that included randomized controlled trials (RCTs) that compared these two therapy options for AF in HF patients. Methods We searched PubMed, Google Scholar, and the Cochrane Library for eligible studies. After reviewing all potential studies, we conducted this meta-analysis with the remaining 10 RCTs. We used a modified Jadad scale to assess the publications’ quality, and we used the Risk of Bias 2 tool to assess the RCTs’ bias risk. Results The meta-analysis comprised 2,187 patients. Patients treated with CA had a lower risk of all-cause mortality than patients treated with MT (RR=0.64 [0.5, 0.82]; p < 0.01). The CA group had greater improvement in left ventricular ejection fraction (LVEF) than the MT group (mean difference [MD]=5.38 [1.80, 8.97]; p < 0.01). Patients in the CA group had longer 6-min walking distances than patients in the MT group (MD=20.3 [−4.37, 44.9], p < 0.01). Compared to the MT group, the CAD group demonstrated a greater reduction in scores on the Minnesota Living with Heart Failure Questionnaire (MD= −9.59 [−16.72, −2.45], p < 0.01). Conclusion This meta-analysis highlights the importance of CA in terms of all-cause mortality and includes the highest number of patients of any study on this topic. Moreover, compared to MT, CA therapy is associated with greater improvements in LVEF and quality of life.