Abstract
Background: Atrial fibrillation (AF) frequently coexists with heart failure (HF) with reduced ejection fraction (EF). This meta-analysis compared AF control strategies, that is, rhythm vs. rate, and catheter ablation (CA) vs. anti-arrhythmic drugs (AAD) in patients with AF combined with HF. Methods and Results: The MEDLINE, EMBASE, and CENTRAL databases were searched, and 13 articles from 11 randomized controlled trials with 5,256 patients were included in this meta-analysis. The outcomes were echocardiographic parameters (left ventricular EF, LVEF), left atrial (LA) size, and left ventricular end-systolic volume, LVESV), clinical outcomes (mortality, hospitalization, and thromboembolism), exercise capacity, and quality of life (QOL). In a random effects model, rhythm control was associated with higher LVEF, better exercise capacity, and better QOL than the rate control. When the 2 different rhythm control strategies were compared (CA vs. AAD), the CA group had significantly decreased LA size and LVESV, and improved LVEF and 6-min walk distance, but mortality, hospitalization, and thromboembolism rates were not different between the rhythm and rate control groups. Conclusions: In AF combined with HF, even though mortality, hospitalization and thromboembolism rates were similar, a rhythm control strategy was superior to rate control in terms of improvement in LVEF, exercise capacity, and QOL. In particular, the CA group was superior to the AAD group for reversal of cardiac remodeling.
| Original language | English |
|---|---|
| Pages (from-to) | 1770-1777 |
| Number of pages | 8 |
| Journal | Circulation Journal |
| Volume | 82 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - 2018 Jan 1 |
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Keywords
- Anti-arrhythmic drug
- Atrial fibrillation
- Catheter ablation
- Heart failure
- Meta-analysis
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Treatment strategies for atrial fibrillation with left ventricular systolic dysfunction ― Meta-analysis. / Ahn, Jinhee; Kim, Hyun Jung; Choe, Jeong Cheon; Park, Jin Sup; Lee, Hye Won; Oh, Jun Hyok; Choi, Jung Hyun; Lee, Han Cheol; Cha, Kwang Soo; Hong, Taek Jong; Kim, Young Hoon.
In: Circulation Journal, Vol. 82, No. 7, 01.01.2018, p. 1770-1777.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Treatment strategies for atrial fibrillation with left ventricular systolic dysfunction ― Meta-analysis
AU - Ahn, Jinhee
AU - Kim, Hyun Jung
AU - Choe, Jeong Cheon
AU - Park, Jin Sup
AU - Lee, Hye Won
AU - Oh, Jun Hyok
AU - Choi, Jung Hyun
AU - Lee, Han Cheol
AU - Cha, Kwang Soo
AU - Hong, Taek Jong
AU - Kim, Young Hoon
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background: Atrial fibrillation (AF) frequently coexists with heart failure (HF) with reduced ejection fraction (EF). This meta-analysis compared AF control strategies, that is, rhythm vs. rate, and catheter ablation (CA) vs. anti-arrhythmic drugs (AAD) in patients with AF combined with HF. Methods and Results: The MEDLINE, EMBASE, and CENTRAL databases were searched, and 13 articles from 11 randomized controlled trials with 5,256 patients were included in this meta-analysis. The outcomes were echocardiographic parameters (left ventricular EF, LVEF), left atrial (LA) size, and left ventricular end-systolic volume, LVESV), clinical outcomes (mortality, hospitalization, and thromboembolism), exercise capacity, and quality of life (QOL). In a random effects model, rhythm control was associated with higher LVEF, better exercise capacity, and better QOL than the rate control. When the 2 different rhythm control strategies were compared (CA vs. AAD), the CA group had significantly decreased LA size and LVESV, and improved LVEF and 6-min walk distance, but mortality, hospitalization, and thromboembolism rates were not different between the rhythm and rate control groups. Conclusions: In AF combined with HF, even though mortality, hospitalization and thromboembolism rates were similar, a rhythm control strategy was superior to rate control in terms of improvement in LVEF, exercise capacity, and QOL. In particular, the CA group was superior to the AAD group for reversal of cardiac remodeling.
AB - Background: Atrial fibrillation (AF) frequently coexists with heart failure (HF) with reduced ejection fraction (EF). This meta-analysis compared AF control strategies, that is, rhythm vs. rate, and catheter ablation (CA) vs. anti-arrhythmic drugs (AAD) in patients with AF combined with HF. Methods and Results: The MEDLINE, EMBASE, and CENTRAL databases were searched, and 13 articles from 11 randomized controlled trials with 5,256 patients were included in this meta-analysis. The outcomes were echocardiographic parameters (left ventricular EF, LVEF), left atrial (LA) size, and left ventricular end-systolic volume, LVESV), clinical outcomes (mortality, hospitalization, and thromboembolism), exercise capacity, and quality of life (QOL). In a random effects model, rhythm control was associated with higher LVEF, better exercise capacity, and better QOL than the rate control. When the 2 different rhythm control strategies were compared (CA vs. AAD), the CA group had significantly decreased LA size and LVESV, and improved LVEF and 6-min walk distance, but mortality, hospitalization, and thromboembolism rates were not different between the rhythm and rate control groups. Conclusions: In AF combined with HF, even though mortality, hospitalization and thromboembolism rates were similar, a rhythm control strategy was superior to rate control in terms of improvement in LVEF, exercise capacity, and QOL. In particular, the CA group was superior to the AAD group for reversal of cardiac remodeling.
KW - Anti-arrhythmic drug
KW - Atrial fibrillation
KW - Catheter ablation
KW - Heart failure
KW - Meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=85049017924&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85049017924&partnerID=8YFLogxK
U2 - 10.1253/circj.CJ-17-1423
DO - 10.1253/circj.CJ-17-1423
M3 - Article
C2 - 29709893
AN - SCOPUS:85049017924
VL - 82
SP - 1770
EP - 1777
JO - Circulation Journal
JF - Circulation Journal
SN - 1346-9843
IS - 7
ER -