scholarly journals Catheter ablation vs antiarrhythmic medication in atrial fibrillation

2019 ◽  
Author(s):  
Eric Manheimer ◽  
Martin Mayer ◽  
Brian S Alper
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Meta Analysis ◽  
Outcome Data ◽  
Reduced Ejection Fraction ◽  
All Cause Mortality ◽  
Mortality Outcome ◽  
Antiarrhythmic Medication ◽  
Meta Analyses

The CABANA and CAPTAF trials report more data on the effects of catheter ablation vs. antiarrhythmic medication on quality of life for patients with atrial fibrillation than previously available systematic reviews. However, these publications do not report data for all-cause mortality and cardiac hospitalization in a form that can be integrated into recent meta-analyses. Recent meta-analysis estimates for the effect of catheter ablation on all-cause mortality suggest a reduction in patients with comorbid heart failure with reduced ejection fraction (HFrEF) (risk ratio [RR] 0.52, 95% CI 0.33 to 0.81, n=732, 5 trials) and an unclear effect in patients without comorbid HFrEF (RR 0.88, 95% CI 0.29 to 2.61, n=710, 4 trials). CABANA (n = 2,204) reported mortality for all patients combined (hazard ratio 0.86, 95% CI 0.65 to 1.15), and subgroup analyses by presence or absence of HFrEF would be useful to determine consistency with other trials and, if consistent, increase precision of pooled effect estimates. CAPTAF (n = 155) (which included almost exclusively patients without comorbid heart failure) did not report the mortality outcome data. Both trials collected data on cardiac hospitalization. A recent meta-analysis suggests a reduction in cardiac hospitalization in patients with comorbid HFrEF (RR 0.63, 95% CI 0.46 to 0.87, n=632, 3 trials) and in patients without comorbid HFrEF (RR 0.32, 95% CI 0.23 to 0.45, n=629, 4 trials). Again, however, the CABANA and CAPTAF trials did not report these data in a way that would allow them to be integrated into existing meta-analyses or did not report these data at all. Reporting key clinical outcomes from these trials with subgrouping by comorbid HFrEF could provide substantially more data than the prior body of evidence and inform best current estimates for this comparison.

scholarly journals Catheter ablation vs antiarrhythmic medication in atrial fibrillation

2019 ◽  
Author(s):  
Eric W Manheimer ◽  
Martin Mayer ◽  
Brian S Alper
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Meta Analysis ◽  
Outcome Data ◽  
Reduced Ejection Fraction ◽  
All Cause Mortality ◽  
Mortality Outcome ◽  
Antiarrhythmic Medication ◽  
Meta Analyses

The CABANA and CAPTAF trials report more data on the effects of catheter ablation vs. antiarrhythmic medication on quality of life for patients with atrial fibrillation than previously available systematic reviews. However, these publications do not report data for all-cause mortality and cardiac hospitalization in a form that can be integrated into recent meta-analyses. Recent meta-analysis estimates for the effect of catheter ablation on all-cause mortality suggest a reduction in patients with comorbid heart failure with reduced ejection fraction (HFrEF) (risk ratio [RR] 0.52, 95% CI 0.33 to 0.81, n=732, 5 trials) and an unclear effect in patients without comorbid HFrEF (RR 0.88, 95% CI 0.29 to 2.61, n=710, 4 trials). CABANA (n = 2,204) reported mortality for all patients combined (hazard ratio 0.86, 95% CI 0.65 to 1.15), and subgroup analyses by presence or absence of HFrEF would be useful to determine consistency with other trials and, if consistent, increase precision of pooled effect estimates. CAPTAF (n = 155) (which included almost exclusively patients without comorbid heart failure) did not report the mortality outcome data. Both trials collected data on cardiac hospitalization. A recent meta-analysis suggests a reduction in cardiac hospitalization in patients with comorbid HFrEF (RR 0.63, 95% CI 0.46 to 0.87, n=632, 3 trials) and in patients without comorbid HFrEF (RR 0.32, 95% CI 0.23 to 0.45, n=629, 4 trials). Again, however, the CABANA and CAPTAF trials did not report these data in a way that would allow them to be integrated into existing meta-analyses or did not report these data at all. Reporting key clinical outcomes from these trials with subgrouping by comorbid HFrEF could provide substantially more data than the prior body of evidence and inform best current estimates for this comparison.

scholarly journals Sex-Related Differences in Catheter Ablation for Patients With Atrial Fibrillation and Heart Failure

2020 ◽  
Vol 7 ◽  
Author(s):  
Tamanna Chibber ◽  
Adrian Baranchuk
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Reduced Ejection Fraction ◽  
Randomized Controlled ◽  
All Cause Mortality ◽  
Study Population ◽  
Gender Based

The coexistence of atrial fibrillation and heart failure significantly increases the risk of all-cause mortality and heart failure hospitalizations. Sex-related differences in all patients undergoing atrial fibrillation catheter ablation include the referral of fewer women for catheter ablation (15–25%), older age of women at ablation, and higher risk of post-ablation recurrence of atrial fibrillation. We searched the existing literature for sex-related differences in patients undergoing atrial fibrillation catheter ablation with a focus on heart failure. Randomized controlled trials assessing atrial fibrillation catheter ablation in patients with heart failure have demonstrated a significant reduction in all-cause mortality and heart failure hospitalizations. Within the eight existing randomized controlled trials on heart failure with reduced ejection fraction, women composed a small proportion of the study population. Only two studies (CASTLE-AF and AATAC-HF) specifically assessed the effect of gender on outcome and showed no difference in post-ablation outcomes. Registry data-based studies assessing sex-related differences in atrial fibrillation catheter ablation in heart failure reveal that women are half as likely as men to undergo ablation. Conflicting data exist on the interaction of gender and heart failure as they may affect peri-ablation and post-ablation long-term outcomes such as atrial fibrillation recurrence or heart failure hospitalizations. In conclusion, existing studies provide insight into the gender-based differences in patients undergoing catheter ablation for atrial fibrillation as it pertains to heart failure. Further prospective studies with higher proportions of female participants are required to accurately determine gender-based differences in this population.

scholarly journals Digoxin Use to Control Ventricular Rate in Patients with Atrial Fibrillation and Heart Failure Is Not Associated with Increased Mortality

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Surbhi Chamaria ◽  
Anand M. Desai ◽  
Pratap C. Reddy ◽  
Brian Olshansky ◽  
Paari Dominic
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Meta Analysis ◽  
Ventricular Rate ◽  
Point Estimate ◽  
Hazard Ratios ◽  
Inverse Variance ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Meta Analyses

Introduction.Digoxin is used to control ventricular rate in atrial fibrillation (AF). There is conflicting evidence regarding safety of digoxin. We aimed to evaluate the risk of mortality with digoxin use in patients with AF using meta-analyses.Methods.PubMed was searched for studies comparing outcomes of patients with AF taking digoxin versus no digoxin, with or without heart failure (HF). Studies were excluded if they reported only a point estimate of mortality, duplicated patient populations, and/or did not report adjusted hazard ratios (HR). The primary endpoint was all-cause mortality. Adjusted HRs were combined using generic inverse variance and log hazard ratios. A multivariate metaregression model was used to explore heterogeneity in studies.Results.Twelve studies with 321,944 patients were included in the meta-analysis. In all AF patients, irrespective of heart failure status, digoxin is associated with increased all-cause mortality (HR [1.23], 95% confidence interval [CI] 1.16–1.31). However, digoxin is not associated with increased mortality in patients with AF and HF (HR [1.08], 95% CI 0.99–1.18). In AF patients without HF digoxin is associated with increased all-cause mortality (HR [1.38], 95% CI 1.12–1.71).Conclusion.In patients with AF and HF, digoxin use is not associated with an increased risk of all-cause mortality when used for rate control.

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