Datasheet1_Efficacy and safety of catheter ablation for atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis.docx

BackgroundCatheter ablation (CA) effectively treats atrial fibrillation (AF) in heart failure (HF) with reduced ejection fraction (HFrEF), improving clinical outcomes. However, its benefits for AF patients with heart failure with preserved ejection fraction (HFpEF) are still unclear.
MethodsWe systematically searched PubMed, Embase, Web of Science, the Cochrane Library, and Scopus for studies investigating outcomes of CA in AF patients with HFpEF. Efficacy indicators included freedom from AF and antiarrhythmic drugs (AAD) free AF elimination. Safety indicators comprised total complications, HF admission, all-cause admission, and all-cause mortality. Sixteen studies with 20,796 patients included in our research.
ResultsThe comprehensive analysis demonstrated that, when comparing CA with medical therapy in HFpEF, no significant differences were observed in terms of HF admissions, all-cause admissions, and all-cause mortality [(OR: 0.42; 95% CI: 0.12–1.51, P = 0.19), (HR: 0.78; 95% CI: 0.48–1.27, P = 0.31), and (OR: 1.10; 95% CI: 0.83–1.44, P = 0.51)], while freedom from AF was significantly higher in CA (OR: 5.88; 95% CI: 2.99–11.54, P < 0.00001). Compared with HFrEF, CA in HFpEF showed similar rates of freedom from AF, AAD-free AF elimination, total complications, and all-cause admission were similar [(OR:0.91; 95% CI: 0.71,1.17, P =0.47), (OR: 0.97; 95% CI: 0.50–1.86, P = 0.93), (OR: 1.27; 95% CI: 0.47–3.41, P = 0.64), (OR: 1.11; 95% CI: 0.72, 1.73; P = 0.63)]. However, CA in HFpEF was associated with lower rates of HF admission and all-cause mortality [(OR: 0.35; 95% CI: 0.20, 0.60; P = 0.0002), (OR: 0.40; 95% CI: 0.18, 0.85; P = 0.02)]. Compared with patients without HF, CA in HFpEF patients exhibited lower rates of AAD-free AF elimination (OR: 0.48; 95% CI: 0.30, 0.75; P = 0.001). However, their rates of freedom from AF and total complications were similar [(OR: 0.70; 95% CI: 0.48, 1.02; P = 0.06), (OR: 0.60; 95% CI: 0.19, 1.90; P = 0.38)].
ConclusionThis meta-analysis conducted provided a comprehensive evaluation of the efficacy and safety of CA in patients with AF and HFpEF. The results suggest that CA may represent a valuable treatment strategy for patients with AF and HFpEF.
Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier (CRD42024514169).

研究背景：导管消融术（Catheter Ablation, CA）可有效治疗射血分数降低型心力衰竭（Heart Failure with Reduced Ejection Fraction, HFrEF）合并心房颤动（Atrial Fibrillation, AF）患者，改善其临床结局。然而，其对于射血分数保留型心力衰竭（Heart Failure with Preserved Ejection Fraction, HFpEF）合并心房颤动患者的获益仍尚不明确。
研究方法：本研究系统性检索了PubMed、Embase、Web of Science、Cochrane图书馆及Scopus数据库，纳入探讨射血分数保留型心力衰竭合并心房颤动患者接受导管消融术预后的相关研究。疗效指标包括无心房颤动复发率及未使用抗心律失常药物（Antiarrhythmic Drugs, AAD）的无房颤复发率；安全性指标包括总并发症发生率、心力衰竭住院率、全因住院率及全因死亡率。本研究最终纳入16项研究，共计20796例患者。
研究结果：荟萃分析结果显示，相较于药物治疗，射血分数保留型心力衰竭合并心房颤动患者接受导管消融术后，心力衰竭住院率、全因住院率及全因死亡率均无显著统计学差异[OR=0.42, 95%CI:0.12~1.51, P=0.19；HR=0.78, 95%CI:0.48~1.27, P=0.31；OR=1.10, 95%CI:0.83~1.44, P=0.51]，但导管消融组的无房颤复发率显著更高（OR=5.88, 95%CI:2.99~11.54, P<0.00001）。相较于射血分数降低型心力衰竭患者，射血分数保留型心力衰竭合并心房颤动患者接受导管消融术后，无房颤复发率、未使用抗心律失常药物的无房颤复发率、总并发症发生率及全因住院率均无显著差异[OR=0.91, 95%CI:0.71~1.17, P=0.47；OR=0.97, 95%CI:0.50~1.86, P=0.93；OR=1.27, 95%CI:0.47~3.41, P=0.64；OR=1.11, 95%CI:0.72~1.73, P=0.63]；但导管消融治疗在射血分数保留型心力衰竭合并心房颤动患者中可降低心力衰竭住院率及全因死亡率[OR=0.35, 95%CI:0.20~0.60, P=0.0002；OR=0.40, 95%CI:0.18~0.85, P=0.02]。相较于无心力衰竭的心房颤动患者，射血分数保留型心力衰竭合并心房颤动患者接受导管消融术后，未使用抗心律失常药物的无房颤复发率更低（OR=0.48, 95%CI:0.30~0.75, P=0.001），但两组的无房颤复发率及总并发症发生率无显著差异[OR=0.70, 95%CI:0.48~1.02, P=0.06；OR=0.60, 95%CI:0.19~1.90, P=0.38]。
研究结论：本项荟萃分析全面评估了导管消融术在射血分数保留型心力衰竭合并心房颤动患者中的疗效与安全性。结果提示，导管消融术或可成为射血分数保留型心力衰竭合并心房颤动患者的一项极具价值的治疗策略。
系统评价注册：https://www.crd.york.ac.uk/PROSPERO/#recordDetails，注册编号（CRD42024514169）。