Mohit K. Turagam, MD *; Jalaj Garg, MD *; William Whang, MD; Samantha Sartori, PhD; Jacob S. Koruth, MD; Marc A. Miller, MD; Noelle Langan, MD; Aamir Sofi, MD; Anthony Gomes, MD; Subbarao Choudry, MD; Srinivas R. Dukkipati, MD; Vivek Y. Reddy, MD
Note: All authors had full access to all data and share responsibility for the decision to submit the manuscript for publication.
Disclosures: Dr. Koruth reports grants from Biosense Webster, LuxCath, Affera, and CardioFocus and grants and personal fees from Abbott and Farapulse. Dr. Dukkipati reports grants from Biosense Webster and advisory board membership at Abiomed outside the submitted work. Dr. Reddy reports grants and personal fees from Abbott, Biosense Webster, Boston Scientific, CardioNXT/AFTx, and Medtronic; personal fees from Biotronik, CardioFocus, Cardionomic, EBR Systems, and Impulse Dynamics; and stock ownership in Acutus Medical, Affera, Apama Medical, Autonomix, Axon, Backbeat, BioSig, Circa Scientific, Corvia Medical, East End Medical, EPD Solutions, EPIX Therapeutics, EpiEP, Eximo, Farapulse, Javelin, Keystone Heart, LuxCath, Manual Surgical Sciences, MedLumics; Middle Peak Medical, Newpace, Surecor, ValCare, and VytronUS, outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0992.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson.
Reproducible Research Statement:Study protocol: See the Supplement. Statistical code: Available from Dr. Reddy (e-mail, firstname.lastname@example.org). Data set: Not applicable.
Corresponding Author: Vivek Y. Reddy, MD, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1030, New York, New York 10029; e-mail, email@example.com.
Current Author Addresses: Dr. Reddy: Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1030, New York, New York 10029.
Drs. Turagam, Garg, Whang, Sartori, Koruth, Miller, Langan, Sofi, Gomes, Choudry, and Dukkipati: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1030, New York, New York 10029.
Author Contributions: Conception and design: M.K. Turagam, J. Garg, W. Whang, V.Y. Reddy.
Analysis and interpretation of the data: M.K. Turagam, J. Garg, S. Sartori, M.A. Miller, A. Gomes, V.Y. Reddy.
Drafting of the article: M.K. Turagam, J. Garg, J.S. Koruth, M.A. Miller, A. Sofi, A. Gomes, S.R. Dukkipati.
Critical revision for important intellectual content: M.K. Turagam, J. Garg, W. Whang, S. Sartori, J.S. Koruth, M.A. Miller, A. Sofi, A. Gomes, S.R. Dukkipati, V.Y. Reddy.
Final approval of the article: M.K. Turagam, J. Garg, W. Whang, S. Sartori, J.S. Koruth, M.A. Miller, N. Langan, A. Sofi, A. Gomes, S. Choudry, S.R. Dukkipati, V.Y. Reddy.
Provision of study materials or patients: M.K. Turagam.
Statistical expertise: M.K. Turagam, J. Garg, S. Sartori.
Administrative, technical, or logistic support: M.K. Turagam, J. Garg, A. Gomes, S. Choudry, V.Y. Reddy.
Collection and assembly of data: M.K. Turagam, J. Garg, S. Sartori, J.S. Koruth, N. Langan.
Atrial fibrillation (AF) and heart failure (HF) frequently coexist and are associated with increased morbidity and mortality risk.
To compare benefits and harms between catheter ablation and drug therapy in adult patients with AF and HF.
ClinicalTrials.gov, PubMed, Web of Science (Clarivate Analytics), EBSCO Information Services, Cochrane Central Register of Controlled Trials, Google Scholar, and various scientific conference sessions from 1 January 2005 to 1 October 2018.
Randomized controlled trials (RCTs) published in English that had at least 6 months of follow-up and compared clinical outcomes of catheter ablation versus drug therapy in adults with AF and HF.
2 investigators independently extracted data and assessed study quality.
6 RCTs involving 775 patients met inclusion criteria. Compared with drug therapy, AF ablation reduced all-cause mortality (9.0% vs. 17.6%; risk ratio [RR], 0.52 [95% CI, 0.33 to 0.81]) and HF hospitalizations (16.4% vs. 27.6%; RR, 0.60 [CI, 0.39 to 0.93]). Ablation improved left ventricular ejection fraction (LVEF) (mean difference, 6.95% [CI, 3.0% to 10.9%]), 6-minute walk test distance (mean difference, 20.93 m [CI, 5.91 to 35.95 m]), peak oxygen consumption (Vo2max) (mean difference, 3.17 mL/kg per minute [CI, 1.26 to 5.07 mL/kg per minute]), and quality of life (mean difference in Minnesota Living with Heart Failure Questionnaire score, −9.02 points [CI, −19.75 to 1.71 points]). Serious adverse events were more common in the ablation groups, although differences between the ablation and drug therapy groups were not statistically significant (7.2% vs. 3.8%; RR, 1.68 [CI, 0.58 to 4.85]).
Results driven primarily by 1 clinical trial, possible patient selection bias in the ablation group, lack of patient-level data, open-label trial designs, and heterogeneous follow-up length among trials.
Catheter ablation was superior to conventional drug therapy in improving all-cause mortality, HF hospitalizations, LVEF, 6-minute walk test distance, Vo2max, and quality of life, with no statistically significant increase in serious adverse events.
Turagam MK, Garg J, Whang W, Sartori S, Koruth JS, Miller MA, et al. Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure: A Meta-analysis of Randomized Controlled Trials. Ann Intern Med. ;170:41–50. doi: 10.7326/M18-0992
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Published: Ann Intern Med. 2019;170(1):41-50.
Published at www.annals.org on 25 December 2018
Cardiac Diagnosis and Imaging, Cardiology, Heart Failure, Hospital Medicine, Rhythm Disorders and Devices.
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