Improved survival in patients with atrial fibrillation and heart failure undergoing catheter ablation compared to medical treatment: A systematic review and meta‐analysis of randomized controlled trials.
Introduction: Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) patients with heart failure (HF) undergoing catheter ablation (CA) as compared to medical therapy. We sought to investigate the benefit of CA on outcomes of patients with AF and HF as compared to medical th...
| Publicado en: | Journal of Cardiovascular Electrophysiology Vol. 33; no. 11; pp. 2356 - 2367 |
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| Autores principales: | , , , , , , , , , , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Nov2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=160149544&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 160149544 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Nov2022 vid: 33 iid: 11 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 160149544 158414711 160149544 160149544 10.1111/jce.15622 160149544 ppf: 2356 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Improved survival in patients with atrial fibrillation and heart failure undergoing catheter ablation compared to medical treatment: A systematic review and meta‐analysis of randomized controlled trials. aug: au: Romero, Jorge Gabr, Mohamed Alviz, Isabella Briceno, David Diaz, Juan Carlos Rodriguez, Daniel Patel, Kavisha Polanco, Dalvert Trivedi, Chintan Mohanty, Sanghamitra Della Rocca, Domenico Lakkireddy, Dhanunjaya Natale, Andrea Di Biase, Luigi affil: Department of Medicine, Cardiac Arrhythmia Center, Montefiore‐Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Division of Cardiology, Albert Einstein College of Medicine, Bronx New York,, USA sug: subj: Atrial Fibrillation Therapy Heart Failure Therapy Catheter Ablation Atrial Fibrillation Prognosis Heart Failure Prognosis Cardiovascular Agents Therapeutic Use Treatment Outcomes Evaluation Human Systematic Review Meta Analysis PubMed Embase Cochrane Library Mortality Risk Factors Arrhythmia, Atrial Recurrence Ventricular Ejection Fraction Cardiac Patients Male Female Middle Age Aged Descriptive Statistics Survival Analysis Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Introduction: Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) patients with heart failure (HF) undergoing catheter ablation (CA) as compared to medical therapy. We sought to investigate the benefit of CA on outcomes of patients with AF and HF as compared to medical therapy. Methods and Results: A systematic review of PubMed, Embase, and Cochrane Central Register of Clinical Trials was performed for clinical studies evaluating the benefit of CA for patients with AF and HF. Primary endpoint was all‐cause mortality. Secondary endpoints included atrial‐arrhythmia recurrence and improvement in left ventricular ejection fraction (LVEF). Eight randomized controlled trials were included with a total of 2121 patients (mean age: 65 ± 5 years; 72% male). Mean follow‐up duration was 32.9 ± 14.5 months. All‐cause mortality in patients who underwent CA was significantly lower than in the medical treatment group (8.8% vs. 13.5%, RR 0.65, 95% confidence interval [CI] 0.51−0.83, p =.0005). A 35% relative risk reduction and 4.7% absolute risk reduction in all‐cause mortality was observed with CA. Rates of all‐atrial arrhythmia recurrence were significantly lower in the CA group (39.9% vs. 69.6%, RR: 0.55, 95% CI: 0.40−0.76, p =.0003). Improvement in LVEF was significantly higher in patients undergoing CA (+9.4 ± 7.6%) as compared to conventional treatment (+3.3 ± 8%) (mean difference 6.2, 95% CI: 3.6−8.8, p <.00001). Conclusion: CA for AF in patients with HF decreases all‐cause mortality, improves all‐atrial arrhythmia recurrence rate and LVEF when compared to medical management. CA should be considered the treatment of choice to improve survival in this select group of patients. Nonetheless, the benefit of CA in patients with severely reduced ejection fraction and New York Heart Association class IV HF has not been clearly elucidated. pubtype: Academic Journal doctype: meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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