Essential Site Maintenance: Authorea-powered sites will be updated circa 15:00-17:00 Eastern on Tuesday 5 November.
There should be no interruption to normal services, but please contact us at [email protected] in case you face any issues.

loading page

Comprehensive Evaluation of Catheter Ablation  versus Medical Therapy in Atrial Fibrillation and Heart Failure: An Umbrella  Review  
  • +9
  • Muhammad Uzair Siddique,
  • Muhammad Hazma Ilyas,
  • Ahmed Arham Niaz,
  • Daniya Waqas,
  • Usama Afraz Younas,
  • safwan safdar,
  • Danish Zahir,
  • Usman Saeed,
  • Ali Shehram,
  • Fatima Tanveer,
  • Ali Ahmad,
  • Taha Nadeem
Muhammad Uzair Siddique
Author Profile
Muhammad Hazma Ilyas
Author Profile
Ahmed Arham Niaz
Author Profile
Daniya Waqas
Author Profile
Usama Afraz Younas
Author Profile
safwan safdar
Author Profile
Danish Zahir
Author Profile
Usman Saeed
Author Profile
Ali Shehram
Author Profile
Fatima Tanveer
Author Profile
Ali Ahmad

Corresponding Author:[email protected]

Author Profile
Taha Nadeem
Author Profile

Abstract

Background: The precise relationship between atrial fibrillation (AF), which affects a significant number of individuals, and heart failure (HF) remains poorly understood. With over 12 million projected cases of AF and 8 million of HF in the United States by 2030, the need for clarity led us to conduct the first-ever umbrella review, aiming to understand the inconsistent findings regarding the efficacy of catheter ablation (CA) versus medical therapy (MT) in this population.
Methods: A comprehensive search was conducted across PubMed, Cochrane Library, and Google Scholar to identify relevant studies for inclusion in this umbrella review. The GRADE method was utilized to assess the overall certainty of the evidence thoroughly. Furthermore, the quality of the included reviews was carefully evaluated using the AMSTAR 2 and Cochrane Collaboration risk of bias tool.
Results:  After careful review, six systematic reviews and meta-analyses were selected for analysis. Notably, Catheter ablation (CA) was associated with a significant reduction in all-cause mortality (RR [95% CI]: 0.55 [0.44, 0.68], I2: 60%, p-value: <0.00001), and Heart failure (HF) hospitalization risk (RR [95% CI]: 0.61 [0.54, 0.70], I2: 0%, p-value: <0.00001), as well as a decrease in atrial fibrillation (AF) recurrence rates (RR [95% CI]: 0.36 [0.27, 0.47], I2: 0%, p-value: <0.00001). Secondary efficacy outcomes, including changes in cardiac function parameters, favored CA over MT, with significant improvements observed in Left ventricular ejection fraction (LVEF) and 6-minute walk test (6MWT).
Conclusion: AF and HF patients who received CA instead of MT had better functional outcomes and safety. The CA group has significantly lower all-cause mortality, HF hospitalization, AF recurrence, and LVEF, 6MWT, and VO2 max improvements than the MT group. Future research should include all participants with HF and AF to obtain a complete analysis.