Meta‐analysis of randomized controlled trials on atrial fibrillation ablation in patients with heart failure with reduced ejection fraction

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