Catheter ablation improves mortality and morbidity in patients with heart failure and atrial fibrillation
Catheter Ablation for Atrial Fibrillation with Heart FailureLiterature - Marrouche NF, Brachmann J, Andresen D, et al. - N Engl J Med 2018;378:417-27
- 363 patients met the inclusion criteria and were followed-up for a mean duration of 37.6±20.4 months in the ablation group (179 patients) and 37.4±17.7 months in the medical therapy group (184 patients).
- The composite primary end point occurred in significantly fewer patients in the ablation group compared with the medical-therapy group (28.5% vs. 44.6%; HR: 0.62; 95%CI: 0.43-0.87; P=0.007).
- Rates of all-cause death were 13.4% in the ablation group and 25.0% in the medical-therapy group (HR: 0.53; 95%CI: 0.32-0.86; P=0.01).
- Rates of HF hospitalizations were 20.7% in the ablation group and 35.9% in the medical-therapy group (HR: 0.56; 95%CI: 0.37-0.83; P=0.004).
- Rates of CV deaths were 11.2% in the ablation group and 22.3% in the medical-therapy group (HR: 0.49; 95%CI: 0.29-0.84; P=0.009).
- The median absolute increase in LVEF was 8.0% (IQ: 2.2-19.1) in the ablation group and 0.2% (IQ: −3.0 to 16.1) in the medical-therapy group (P=0.005). Sinus rhythm was achieved in 63.1% of the patients in the ablation group and in 21.7% of patients in the medical-therapy group (P<0.001).
Catheter ablation is associated with a lower mortality and morbidity rate compared to medical therapy in patients with HF and AF. Moreover, catheter ablation improved the LVEF and reduced the burden of AF.