Abstract
Byline: Mustafa Alam, NYIT College of Osteopathic Medicine, Mesa, AZ; Omar Javed Baqal, Mayo Clinic Arizona, PHOENIX, AZ; Sunny Jhamnani, CommonSpirit Health, Phoenix, AZ Introduction: Atrial fibrillation (AF) remains a significant cause of morbidity and mortality in the United States. Optimal management of AF in heart failure (HF) patients remains a controversy. Recent studies have demonstrated favorable outcomes of catheter ablation versus medical therapy. The purpose of this meta-analysis is to investigate whether catheter ablation achieves better outcomes as compared to rate control. Methods: A systematic search of MEDLINE was conducted using PRISMA guidelines with the search terms "rate control", "atrial fibrillation", and "ablation." Studies were included if they compared a catheter ablation strategy versus rate control medical therapy in HF patients. Multiple endpoints were extracted from the articles including LVEF, 6MWD, change in BNP, and Quality of Life (QoL) outcomes using the Cochrane manual. Revman 5.4 was used to aggregate the outcomes and compute statistics using a random effects model to create forest plots. Results: A total of 7 studies with 1065 patients were included in this analysis. LVEF increased by 5.69% [4.80, 6.58] p<0.00001, 6MWD increased by 24.82m [2.69, 46.94] p=0.03, BNP decreased -102.54 [-174.68, -30.40] p=0.005, and QoL outcomes using the MLHFQ improved -8.10 [-15.73, -0.48] p=0.04. Conclusions: Catheter ablation improves outcomes in HF patients with atrial fibrillation as compared to a rate control only strategy. Further large-scale randomized studies are needed to quantify improvements in outcomes.