Heart failure with preserved ejection fraction and atrial fibrillation: catheter ablation vs. standard medical therapy — a systematic review and meta-analysis
Background The latest guidelines advocate for catheter ablation (CA) over standard medical therapy (SMT) for managing atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). However, significant knowledge gaps exist regarding the effectiveness of CA vs. SMT in...
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| Veröffentlicht in: | Heart failure reviews 2025-01, Vol.30 (1), p.1-15 |
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| creator | Mahalleh, Mehrdad Soleimani, Hamidreza Pazoki, Mohammadreza Maleki, Saba Dastjerdi, Parham Ebrahimi, Pouya Zafarmandi, Sahar Khamene, Sima Shamshiri Khawajah, Izat Mohammad Tabassum, Shehroze Bhardwaj, Rahul Mattumpuram, Jishanth Kaplan, Andrew Vaseghi, Marmar Seilani, Parisa Bozorgi, Ali Hosseini, Kaveh Tzeis, Stylianos |
| description | Background
The latest guidelines advocate for catheter ablation (CA) over standard medical therapy (SMT) for managing atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). However, significant knowledge gaps exist regarding the effectiveness of CA vs. SMT in patients with heart failure with preserved ejection fraction (HFpEF).
Methods
PubMed, Scopus, and Embase until February 2024 were systematically searched. Given the limited number of randomized studies, propensity score-matched observational studies comparing CA with SMT in AF patients with HFpEF were also included. The primary outcome was a composite endpoint of all-cause mortality and HF hospitalization.
Results
Eight studies that enrolled 17,717 SMT and 2537 CA patients were included. CA was associated with a significantly lower risk of the composite endpoint of all-cause mortality and HF hospitalization (HR 0.61; 95% CI, 0.43–0.85). The risk of HF hospitalization (HR 0.44; 95% CI, 0.23–0.83), cardiovascular mortality (HR 0.43; 95% CI, 0.22–0.84), and AF recurrence (HR 0.53; 95% CI, 0.39–0.73) were also lower in the CA group.
Conclusion
CA demonstrated significant cardiovascular morbidity and mortality benefits compared to SMT in the HFpEF population. |
| doi_str_mv | 10.1007/s10741-024-10437-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3105492236</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3144438704</sourcerecordid><originalsourceid>FETCH-LOGICAL-c256t-313d884534b50f5997c3d33385b1ca5eb7e942b5f6d82908891fd9f8e99748093</originalsourceid><addsrcrecordid>eNp9kUtuFDEQhi1ERMLABVggS2yy6cTPsc0ORYEgRWIDa8vtLhOP-jHY7olmxyE4QM6Wk-BJh4dYsHKp6vt_u_wj9IqSM0qIOs-UKEEbwkRDieCq4U_QCZWKN4oz9vSv-hg9z3lDCBFGkGfomBumtDHsBN1dgUsFBxf7OQG-jeUGbxNkSDvoMGzAlziNOCS3FG7ssCspuh6H2KbY9-7Qf4u9KzdQIGHXLi28y2c4lypwqcMDdNFXUYWS2-7x_fcf2OG8zwWGinucYBfh9sF_gOIaN7p-n2N-gY6C6zO8fDxX6Mv7y88XV831pw8fL95dN57JdWk45Z3WQnLRShKkMcrzjnOuZUu9k9AqMIK1Mqw7zQzR2tDQmaChkkITw1fodPHdpunbDLnYIWYPdb8RpjlbTokUhjG-ruibf9DNNKf63gMlhOBa1ThWiC2UT1POCYLdpji4tLeU2EN-dsnP1vzsQ36WV9HrR-u5rV_2W_IrsArwBch1NH6F9Ofu_9j-BIoQqG0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3144438704</pqid></control><display><type>article</type><title>Heart failure with preserved ejection fraction and atrial fibrillation: catheter ablation vs. standard medical therapy — a systematic review and meta-analysis</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Mahalleh, Mehrdad ; Soleimani, Hamidreza ; Pazoki, Mohammadreza ; Maleki, Saba ; Dastjerdi, Parham ; Ebrahimi, Pouya ; Zafarmandi, Sahar ; Khamene, Sima Shamshiri ; Khawajah, Izat Mohammad ; Tabassum, Shehroze ; Bhardwaj, Rahul ; Mattumpuram, Jishanth ; Kaplan, Andrew ; Vaseghi, Marmar ; Seilani, Parisa ; Bozorgi, Ali ; Hosseini, Kaveh ; Tzeis, Stylianos</creator><creatorcontrib>Mahalleh, Mehrdad ; Soleimani, Hamidreza ; Pazoki, Mohammadreza ; Maleki, Saba ; Dastjerdi, Parham ; Ebrahimi, Pouya ; Zafarmandi, Sahar ; Khamene, Sima Shamshiri ; Khawajah, Izat Mohammad ; Tabassum, Shehroze ; Bhardwaj, Rahul ; Mattumpuram, Jishanth ; Kaplan, Andrew ; Vaseghi, Marmar ; Seilani, Parisa ; Bozorgi, Ali ; Hosseini, Kaveh ; Tzeis, Stylianos</creatorcontrib><description>Background
The latest guidelines advocate for catheter ablation (CA) over standard medical therapy (SMT) for managing atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). However, significant knowledge gaps exist regarding the effectiveness of CA vs. SMT in patients with heart failure with preserved ejection fraction (HFpEF).
Methods
PubMed, Scopus, and Embase until February 2024 were systematically searched. Given the limited number of randomized studies, propensity score-matched observational studies comparing CA with SMT in AF patients with HFpEF were also included. The primary outcome was a composite endpoint of all-cause mortality and HF hospitalization.
Results
Eight studies that enrolled 17,717 SMT and 2537 CA patients were included. CA was associated with a significantly lower risk of the composite endpoint of all-cause mortality and HF hospitalization (HR 0.61; 95% CI, 0.43–0.85). The risk of HF hospitalization (HR 0.44; 95% CI, 0.23–0.83), cardiovascular mortality (HR 0.43; 95% CI, 0.22–0.84), and AF recurrence (HR 0.53; 95% CI, 0.39–0.73) were also lower in the CA group.
Conclusion
CA demonstrated significant cardiovascular morbidity and mortality benefits compared to SMT in the HFpEF population.</description><identifier>ISSN: 1573-7322</identifier><identifier>ISSN: 1382-4147</identifier><identifier>EISSN: 1573-7322</identifier><identifier>DOI: 10.1007/s10741-024-10437-3</identifier><identifier>PMID: 39278992</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Ablation ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Atrial Fibrillation - therapy ; Cardiac arrhythmia ; Cardiology ; Cardiovascular diseases ; Catheter Ablation - methods ; Catheters ; Congestive heart failure ; Ejection fraction ; Fibrillation ; Heart failure ; Heart Failure - mortality ; Heart Failure - physiopathology ; Hospitalization ; Humans ; Medicine ; Medicine & Public Health ; Meta-analysis ; Morbidity ; Mortality ; Radiofrequency ablation ; Review ; Stroke Volume - physiology</subject><ispartof>Heart failure reviews, 2025-01, Vol.30 (1), p.1-15</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024 Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>Copyright Springer Nature B.V. Jan 2025</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-313d884534b50f5997c3d33385b1ca5eb7e942b5f6d82908891fd9f8e99748093</cites><orcidid>0000-0002-9701-9706 ; 0000-0002-6210-2112 ; 0000-0002-3115-5545 ; 0009-0005-3694-6863 ; 0000-0002-6359-3435 ; 0009-0001-0804-7511 ; 0000-0001-5676-3099 ; 0000-0003-2802-4613</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10741-024-10437-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10741-024-10437-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39278992$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mahalleh, Mehrdad</creatorcontrib><creatorcontrib>Soleimani, Hamidreza</creatorcontrib><creatorcontrib>Pazoki, Mohammadreza</creatorcontrib><creatorcontrib>Maleki, Saba</creatorcontrib><creatorcontrib>Dastjerdi, Parham</creatorcontrib><creatorcontrib>Ebrahimi, Pouya</creatorcontrib><creatorcontrib>Zafarmandi, Sahar</creatorcontrib><creatorcontrib>Khamene, Sima Shamshiri</creatorcontrib><creatorcontrib>Khawajah, Izat Mohammad</creatorcontrib><creatorcontrib>Tabassum, Shehroze</creatorcontrib><creatorcontrib>Bhardwaj, Rahul</creatorcontrib><creatorcontrib>Mattumpuram, Jishanth</creatorcontrib><creatorcontrib>Kaplan, Andrew</creatorcontrib><creatorcontrib>Vaseghi, Marmar</creatorcontrib><creatorcontrib>Seilani, Parisa</creatorcontrib><creatorcontrib>Bozorgi, Ali</creatorcontrib><creatorcontrib>Hosseini, Kaveh</creatorcontrib><creatorcontrib>Tzeis, Stylianos</creatorcontrib><title>Heart failure with preserved ejection fraction and atrial fibrillation: catheter ablation vs. standard medical therapy — a systematic review and meta-analysis</title><title>Heart failure reviews</title><addtitle>Heart Fail Rev</addtitle><addtitle>Heart Fail Rev</addtitle><description>Background
The latest guidelines advocate for catheter ablation (CA) over standard medical therapy (SMT) for managing atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). However, significant knowledge gaps exist regarding the effectiveness of CA vs. SMT in patients with heart failure with preserved ejection fraction (HFpEF).
Methods
PubMed, Scopus, and Embase until February 2024 were systematically searched. Given the limited number of randomized studies, propensity score-matched observational studies comparing CA with SMT in AF patients with HFpEF were also included. The primary outcome was a composite endpoint of all-cause mortality and HF hospitalization.
Results
Eight studies that enrolled 17,717 SMT and 2537 CA patients were included. CA was associated with a significantly lower risk of the composite endpoint of all-cause mortality and HF hospitalization (HR 0.61; 95% CI, 0.43–0.85). The risk of HF hospitalization (HR 0.44; 95% CI, 0.23–0.83), cardiovascular mortality (HR 0.43; 95% CI, 0.22–0.84), and AF recurrence (HR 0.53; 95% CI, 0.39–0.73) were also lower in the CA group.
Conclusion
CA demonstrated significant cardiovascular morbidity and mortality benefits compared to SMT in the HFpEF population.</description><subject>Ablation</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Atrial Fibrillation - therapy</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Cardiovascular diseases</subject><subject>Catheter Ablation - methods</subject><subject>Catheters</subject><subject>Congestive heart failure</subject><subject>Ejection fraction</subject><subject>Fibrillation</subject><subject>Heart failure</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - physiopathology</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Radiofrequency ablation</subject><subject>Review</subject><subject>Stroke Volume - physiology</subject><issn>1573-7322</issn><issn>1382-4147</issn><issn>1573-7322</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtuFDEQhi1ERMLABVggS2yy6cTPsc0ORYEgRWIDa8vtLhOP-jHY7olmxyE4QM6Wk-BJh4dYsHKp6vt_u_wj9IqSM0qIOs-UKEEbwkRDieCq4U_QCZWKN4oz9vSv-hg9z3lDCBFGkGfomBumtDHsBN1dgUsFBxf7OQG-jeUGbxNkSDvoMGzAlziNOCS3FG7ssCspuh6H2KbY9-7Qf4u9KzdQIGHXLi28y2c4lypwqcMDdNFXUYWS2-7x_fcf2OG8zwWGinucYBfh9sF_gOIaN7p-n2N-gY6C6zO8fDxX6Mv7y88XV831pw8fL95dN57JdWk45Z3WQnLRShKkMcrzjnOuZUu9k9AqMIK1Mqw7zQzR2tDQmaChkkITw1fodPHdpunbDLnYIWYPdb8RpjlbTokUhjG-ruibf9DNNKf63gMlhOBa1ThWiC2UT1POCYLdpji4tLeU2EN-dsnP1vzsQ36WV9HrR-u5rV_2W_IrsArwBch1NH6F9Ofu_9j-BIoQqG0</recordid><startdate>20250101</startdate><enddate>20250101</enddate><creator>Mahalleh, Mehrdad</creator><creator>Soleimani, Hamidreza</creator><creator>Pazoki, Mohammadreza</creator><creator>Maleki, Saba</creator><creator>Dastjerdi, Parham</creator><creator>Ebrahimi, Pouya</creator><creator>Zafarmandi, Sahar</creator><creator>Khamene, Sima Shamshiri</creator><creator>Khawajah, Izat Mohammad</creator><creator>Tabassum, Shehroze</creator><creator>Bhardwaj, Rahul</creator><creator>Mattumpuram, Jishanth</creator><creator>Kaplan, Andrew</creator><creator>Vaseghi, Marmar</creator><creator>Seilani, Parisa</creator><creator>Bozorgi, Ali</creator><creator>Hosseini, Kaveh</creator><creator>Tzeis, Stylianos</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9701-9706</orcidid><orcidid>https://orcid.org/0000-0002-6210-2112</orcidid><orcidid>https://orcid.org/0000-0002-3115-5545</orcidid><orcidid>https://orcid.org/0009-0005-3694-6863</orcidid><orcidid>https://orcid.org/0000-0002-6359-3435</orcidid><orcidid>https://orcid.org/0009-0001-0804-7511</orcidid><orcidid>https://orcid.org/0000-0001-5676-3099</orcidid><orcidid>https://orcid.org/0000-0003-2802-4613</orcidid></search><sort><creationdate>20250101</creationdate><title>Heart failure with preserved ejection fraction and atrial fibrillation: catheter ablation vs. standard medical therapy — a systematic review and meta-analysis</title><author>Mahalleh, Mehrdad ; Soleimani, Hamidreza ; Pazoki, Mohammadreza ; Maleki, Saba ; Dastjerdi, Parham ; Ebrahimi, Pouya ; Zafarmandi, Sahar ; Khamene, Sima Shamshiri ; Khawajah, Izat Mohammad ; Tabassum, Shehroze ; Bhardwaj, Rahul ; Mattumpuram, Jishanth ; Kaplan, Andrew ; Vaseghi, Marmar ; Seilani, Parisa ; Bozorgi, Ali ; Hosseini, Kaveh ; Tzeis, Stylianos</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-313d884534b50f5997c3d33385b1ca5eb7e942b5f6d82908891fd9f8e99748093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Ablation</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Atrial Fibrillation - therapy</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Cardiovascular diseases</topic><topic>Catheter Ablation - methods</topic><topic>Catheters</topic><topic>Congestive heart failure</topic><topic>Ejection fraction</topic><topic>Fibrillation</topic><topic>Heart failure</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - physiopathology</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Radiofrequency ablation</topic><topic>Review</topic><topic>Stroke Volume - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mahalleh, Mehrdad</creatorcontrib><creatorcontrib>Soleimani, Hamidreza</creatorcontrib><creatorcontrib>Pazoki, Mohammadreza</creatorcontrib><creatorcontrib>Maleki, Saba</creatorcontrib><creatorcontrib>Dastjerdi, Parham</creatorcontrib><creatorcontrib>Ebrahimi, Pouya</creatorcontrib><creatorcontrib>Zafarmandi, Sahar</creatorcontrib><creatorcontrib>Khamene, Sima Shamshiri</creatorcontrib><creatorcontrib>Khawajah, Izat Mohammad</creatorcontrib><creatorcontrib>Tabassum, Shehroze</creatorcontrib><creatorcontrib>Bhardwaj, Rahul</creatorcontrib><creatorcontrib>Mattumpuram, Jishanth</creatorcontrib><creatorcontrib>Kaplan, Andrew</creatorcontrib><creatorcontrib>Vaseghi, Marmar</creatorcontrib><creatorcontrib>Seilani, Parisa</creatorcontrib><creatorcontrib>Bozorgi, Ali</creatorcontrib><creatorcontrib>Hosseini, Kaveh</creatorcontrib><creatorcontrib>Tzeis, Stylianos</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Heart failure reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mahalleh, Mehrdad</au><au>Soleimani, Hamidreza</au><au>Pazoki, Mohammadreza</au><au>Maleki, Saba</au><au>Dastjerdi, Parham</au><au>Ebrahimi, Pouya</au><au>Zafarmandi, Sahar</au><au>Khamene, Sima Shamshiri</au><au>Khawajah, Izat Mohammad</au><au>Tabassum, Shehroze</au><au>Bhardwaj, Rahul</au><au>Mattumpuram, Jishanth</au><au>Kaplan, Andrew</au><au>Vaseghi, Marmar</au><au>Seilani, Parisa</au><au>Bozorgi, Ali</au><au>Hosseini, Kaveh</au><au>Tzeis, Stylianos</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Heart failure with preserved ejection fraction and atrial fibrillation: catheter ablation vs. standard medical therapy — a systematic review and meta-analysis</atitle><jtitle>Heart failure reviews</jtitle><stitle>Heart Fail Rev</stitle><addtitle>Heart Fail Rev</addtitle><date>2025-01-01</date><risdate>2025</risdate><volume>30</volume><issue>1</issue><spage>1</spage><epage>15</epage><pages>1-15</pages><issn>1573-7322</issn><issn>1382-4147</issn><eissn>1573-7322</eissn><abstract>Background
The latest guidelines advocate for catheter ablation (CA) over standard medical therapy (SMT) for managing atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). However, significant knowledge gaps exist regarding the effectiveness of CA vs. SMT in patients with heart failure with preserved ejection fraction (HFpEF).
Methods
PubMed, Scopus, and Embase until February 2024 were systematically searched. Given the limited number of randomized studies, propensity score-matched observational studies comparing CA with SMT in AF patients with HFpEF were also included. The primary outcome was a composite endpoint of all-cause mortality and HF hospitalization.
Results
Eight studies that enrolled 17,717 SMT and 2537 CA patients were included. CA was associated with a significantly lower risk of the composite endpoint of all-cause mortality and HF hospitalization (HR 0.61; 95% CI, 0.43–0.85). The risk of HF hospitalization (HR 0.44; 95% CI, 0.23–0.83), cardiovascular mortality (HR 0.43; 95% CI, 0.22–0.84), and AF recurrence (HR 0.53; 95% CI, 0.39–0.73) were also lower in the CA group.
Conclusion
CA demonstrated significant cardiovascular morbidity and mortality benefits compared to SMT in the HFpEF population.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>39278992</pmid><doi>10.1007/s10741-024-10437-3</doi><tpages>15</tpages><orcidid>https://orcid.org/0000-0002-9701-9706</orcidid><orcidid>https://orcid.org/0000-0002-6210-2112</orcidid><orcidid>https://orcid.org/0000-0002-3115-5545</orcidid><orcidid>https://orcid.org/0009-0005-3694-6863</orcidid><orcidid>https://orcid.org/0000-0002-6359-3435</orcidid><orcidid>https://orcid.org/0009-0001-0804-7511</orcidid><orcidid>https://orcid.org/0000-0001-5676-3099</orcidid><orcidid>https://orcid.org/0000-0003-2802-4613</orcidid></addata></record> |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Ablation Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Atrial Fibrillation - therapy Cardiac arrhythmia Cardiology Cardiovascular diseases Catheter Ablation - methods Catheters Congestive heart failure Ejection fraction Fibrillation Heart failure Heart Failure - mortality Heart Failure - physiopathology Hospitalization Humans Medicine Medicine & Public Health Meta-analysis Morbidity Mortality Radiofrequency ablation Review Stroke Volume - physiology |
| title | Heart failure with preserved ejection fraction and atrial fibrillation: catheter ablation vs. standard medical therapy — a systematic review and meta-analysis |
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