Catheter ablation versus medical therapy for atrial fibrillation in patients with heart failure with preserved ejection fraction: A systematic review and meta-analysis

BACKGROUND The benefit of catheter ablation for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) remains uncertain. OBJECTIVE We performed a systematic review and meta-analysis to compare catheter ablation and medical therapy (antiarrhythmics for rhythm or rate control) in patients with AF and HFpEF. METHODS We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials. Outcomes were the composite end points of death or heart failure (HF) hospitalization, all-cause death, cardiovascular death, all-cause rehospitalization, and HF hospitalization. Statistical analysis was performed using R statistical software, version 4.3.2 (R Foundation for Statistical Computing). Heterogeneity was assessed with I2 statistics. RESULTS We included 20,257 patients from 8 studies. Of those, 3 were derived from RCTs, either through post hoc analysis or subgroup analysis, and 5 were observational studies. The median follow-up ranged from 24.6 to 61.2 months. Compared with medical therapy, catheter ablation was associated with a statistically significant lower risk of death or HF hospitalization (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.47-0.83; P = .001; I2 = 66%), all-cause death (HR 0.68; 95% CI 0.46-0.99; P = .047; I2 = 61%), cardiovascular death (HR 0.42; 95% CI 0.21-0.84; P = .014; I2 = 22%), and HF hospitalization (HR 0.43; 95% CI 0.23-0.82; P = .011; I2 = 87%). CONCLUSION In this meta-analysis, catheter ablation was associated with a lower risk of all-cause death, cardiovascular death, HF hospitalization, and all-cause rehospitalization in comparison to medical therapy in patients with AF and HFpEF.