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Cardiovascular Therapeutics 2019Atrial fibrillation (AF) and heart failure (HF) are two common conditions that often coexist and predispose each to one another. AF increases hospitalization rates and... (Meta-Analysis)
Meta-Analysis
Atrial fibrillation (AF) and heart failure (HF) are two common conditions that often coexist and predispose each to one another. AF increases hospitalization rates and overall mortality in patients with HF. The current available therapeutic options for AF in patients with HF are diverse and guidelines do not provide a clear consensus regarding the best management approach. To determine if catheter ablation for AF is superior to medical therapy alone in patients with coexisting HF, we conducted this systematic review and meta-analysis. The primary outcomes evaluated are left ventricular ejection fraction (LVEF), Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores, 6-minute walk test (6MWT) distance, heart failure hospitalizations, and mortality. The results are presented as a mean difference for continuous outcome measures and odds ratios for dichotomous outcomes (using Mantel-Haenszel random effects model). 7 full texts met inclusion criteria, including 856 patients. AF catheter ablation was associated with a significant increase in LVEF (mean difference 6.8%; 95% CI: 3.5 - 10.1; P<0.001) and 6MWT (mean difference 29.3; 95% CI: 11.8 - 46.8; P = 0.001), and improvement in MLWHFQ (mean difference -12.1; 95% CI: -20.9 - -3.3; P = 0.007). The risk of all-cause mortality was significantly lower in the AF ablation arm (OR 0.49; 95% CI: 0.31 - 0.77; P = 0.002). In conclusion, atrial fibrillation ablation in patients with systolic heart failure is associated with significant improvement in LVEF, quality of life, 6MWT, and overall mortality.
Topics: Aged; Atrial Fibrillation; Catheter Ablation; Comorbidity; Exercise Tolerance; Female; Heart Failure, Systolic; Humans; Male; Middle Aged; Quality of Life; Recovery of Function; Risk Factors; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left
PubMed: 31772616
DOI: 10.1155/2019/8181657 -
Indian Pacing and Electrophysiology... 2024While atrial fibrillation (AF) ablation has proven beneficial for heart failure (HF) patients, most reports were performed with radiofrequency ablation. We aimed to...
INTRODUCTION
While atrial fibrillation (AF) ablation has proven beneficial for heart failure (HF) patients, most reports were performed with radiofrequency ablation. We aimed to evaluate the efficacy and safety of cryoballoon AF ablation in patients with HFrEF.
METHOD
We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to December 2022. Studies that reported the outcomes of freedom from atrial arrhythmia, complications, NYHA functional class (NYHA FC), and left ventricular ejection fraction (LVEF) after Cryoballoon AF ablation in HF patients were included. Data from each study were combined with a random-effects model.
RESULT
A total of 9 studies observational studies with 1414 HF patients were included. Five studies had only HF with reduced ejection fraction (HFrEF), 1 study with HF with preserved ejection fraction (HFpEF), and others with mixed HF types. Freedom from AA in HFrEF at 12 months was 64% (95% CI 56-71%, I 58%). There was a significant improvement of LVEF in these patients with a standard mean difference of 13% (95% CI 8.6-17.5%, I 99% P < 0.001. The complication rate in HFrEF group was 6% (95% CI 4-10%, I 0%). The risk of recurrence of atrial arrhythmia was not significantly different between HF and no HF patients (RR 1.34, 95% CI 0.8-2.23, I2 76%).
CONCLUSION
Cryoballoon AF ablation is effective in HFrEF patients comparable to radiofrequency ablation. The complication rate was low.
PubMed: 38218450
DOI: 10.1016/j.ipej.2024.01.001 -
Global Heart May 2020Major structural cardiovascular diseases are associated with cardiac arrhythmias, but their full spectrum remains unknown in sub-Saharan Africa (SSA), which we addressed...
UNLABELLED
Major structural cardiovascular diseases are associated with cardiac arrhythmias, but their full spectrum remains unknown in sub-Saharan Africa (SSA), which we addressed in this systematic review. Atrial fibrillation/atrial flutter (AF/AFL) prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, but <1% in the general population. Use of oral anticoagulation is heterogenous (9-79%) across SSA. The epidemiology of sudden cardiac arrest/death is less characterized in SSA. Cardiopulmonary resuscitation is challenging, owing to low awareness and lack of equipment for life-support. About 18% of SSA countries have no cardiac implantable electronic devices services, leaving hundreds of millions of people without any access to treatment for advanced bradyarrhythmias, and implant rates are more than 200-fold lower than in the western world. Management of tachyarrhythmias is largely non-invasive (about 80% AF/AFL via rate-controlled strategy only), as electrophysiological study and catheter ablation centers are almost non-existent in most countries.
HIGHLIGHTS
- Atrial fibrillation/flutter prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, and <1% in the general population in sub-Saharan Africa (SSA).- Rates of oral anticoagulation use for CHA2DS2VASC score ≥2 are very diverse (9-79%) across SSA countries.- Data on sudden cardiac arrest are scant in SSA with low cardiopulmonary resuscitation awareness.- Low rates of cardiac implantable electronic devices insertions and rarity of invasive arrhythmia treatment centers are seen in SSA, relative to the high-income countries.
Topics: Africa South of the Sahara; Arrhythmias, Cardiac; Humans; Morbidity
PubMed: 32923331
DOI: 10.5334/gh.808 -
Open Heart 2019Cardiac resynchronisation therapy (CRT) is beneficial in selected patients with heart failure (HF) in normal sinus rhythm (NSR). We sought to evaluate the impact of CRT...
BACKGROUND
Cardiac resynchronisation therapy (CRT) is beneficial in selected patients with heart failure (HF) in normal sinus rhythm (NSR). We sought to evaluate the impact of CRT with or without atrioventricular junction (AVJ) ablation in patients with HF with concomitant atrial fibrillation (AF).
METHODS AND RESULTS
Literature was searched (inception through 30 August 2017) for observational studies that reported outcomes in patients with HF with CRT and AF that reported all-cause and cardiovascular mortality. Thirty-one studies with 83, 571 patients were included. CRT did not decrease mortality compared with internal cardioverter defibrillator or medical therapy alone in patients with HF and AF with indications for CRT (OR: 0.851, 95% CI 0.616 to 1.176, p=0.328, I=86.954). CRT-AF patients had significantly higher all-cause and cardiovascular mortality than CRT-NSR patients ([OR: 1.472, 95% CI 1.301 to 1.664, p=0.000] and [OR: 1.857, 95% CI 1.350 to 2.554, p=0.000] respectively). Change in left ventricular ejection fraction was not different between CRT patients with and without AF (p=0.705). AVJ ablation, however, improved all-cause mortality in CRT-AF patients when compared with CRT-AF patients without AVJ ablation (OR: 0.485, 95% CI 0.247 to 0.952, p=0.035). With AVJ ablation, there was no difference in all-cause mortality in CRT-AF patients compared with CRT-NSR patients (OR: 1.245, 95% CI 0.914 to 1.696, p=0.165).
CONCLUSION
The results of our meta-analysis suggest that AF was associated with decreased CRT benefits in patients with HF. CRT, however, benefits patients with AF with AVJ ablation.
PubMed: 31217991
DOI: 10.1136/openhrt-2018-000937 -
Clinical Cardiology Nov 2018The role of catheter ablation (CA) is increasingly recognized as a reasonable therapeutic option in patients with atrial fibrillation (AF) and heart failure (HF). (Meta-Analysis)
Meta-Analysis
BACKGROUND
The role of catheter ablation (CA) is increasingly recognized as a reasonable therapeutic option in patients with atrial fibrillation (AF) and heart failure (HF).
HYPOTHESIS
We aimed to compare CA to medical therapy in AF patients with HF with reduced ejection fraction (HFrEF).
METHODS
We searched the literature for randomized clinical trials comparing CA to medical therapy in this population.
RESULTS
Six trials with a total of 775 patients were included. AF was persistent in 95% of patients with a mean duration of 18.5 ± 23 months prior enrollment. The mean age was 62.2 ± 7.8 years, mostly males (83%) with mean left ventricular ejection fraction (LVEF) of 31.2 ± 6.7%. Compared to medical therapy, CA has significantly improved LVEF by 5.9% (Mean difference [MD] 5.93, confidence interval [CI] 3.59-8.27, P < 0.00001, I = 87%), quality of life, (MD -9.01, CI -15.56, -2.45, P = 0.007, I = 47%), and functional capacity (MD 25.82, CI 5.46-46.18, P = 0.01, I = 90%). CA has less HF hospital readmissions (odds ratio [OR] 0.5, CI 0.32-0.78, P = 0.002, I = 0%) and death from any cause (OR 0.46, CI 0.29-0.73, P = 0.0009, I = 0%). Freedom from AF during follow-up was higher in patients who had CA (OR 24.2, CI 6.94-84.41, P < 0.00001, I = 81%.
CONCLUSION
CA was superior to medical therapy in patients with AF and HFrEF in terms of symptoms, hemodynamic response, and clinical outcomes by reducing AF burden. However, these findings are applicable to the very specific patients enrolled in these trials.
Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Catheter Ablation; Comorbidity; Female; Heart Failure; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Risk Factors; Stroke Volume; Treatment Outcome; Ventricular Function, Left
PubMed: 30178507
DOI: 10.1002/clc.23068 -
JACC. Clinical Electrophysiology Oct 2020
Topics: Cardiomyopathies; Catheter Ablation; Humans; Tachycardia, Ventricular
PubMed: 33121677
DOI: 10.1016/j.jacep.2020.06.019