Treatment strategies for atrial fibrillation with left ventricular systolic dysfunction ― Meta-analysis

Jinhee Ahn, Hyun Jung Kim, Jeong Cheon Choe, Jin Sup Park, Hye Won Lee, Jun Hyok Oh, Jung Hyun Choi, Han Cheol Lee, Kwang Soo Cha, Taek Jong Hong, Young Hoon Kim

Research output: Contribution to journalArticle

1 Citation (Scopus)

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 languageEnglish
Pages (from-to)1770-1777
Number of pages8
JournalCirculation Journal
Volume82
Issue number7
DOIs
Publication statusPublished - 2018 Jan 1

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Catheter Ablation
Left Ventricular Dysfunction
Atrial Fibrillation
Meta-Analysis
Anti-Arrhythmia Agents
Thromboembolism
Hospitalization
Heart Failure
Quality of Life
Exercise
Stroke Volume
Mortality
Pharmaceutical Preparations
Therapeutics
MEDLINE
Randomized Controlled Trials
Databases
Control Groups

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 journalArticle

Ahn, J, Kim, HJ, Choe, JC, Park, JS, Lee, HW, Oh, JH, Choi, JH, Lee, HC, Cha, KS, Hong, TJ & Kim, YH 2018, 'Treatment strategies for atrial fibrillation with left ventricular systolic dysfunction ― Meta-analysis', Circulation Journal, vol. 82, no. 7, pp. 1770-1777. https://doi.org/10.1253/circj.CJ-17-1423
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. / Treatment strategies for atrial fibrillation with left ventricular systolic dysfunction ― Meta-analysis. In: Circulation Journal. 2018 ; Vol. 82, No. 7. pp. 1770-1777.
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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

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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.

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