Confirmed: AFib ablation more beneficial for patients with HFrEF than those with HFpEF
Catheter ablation is known to benefit patients who present with atrial fibrillation (AFib) and heart failure with reduced ejection fraction (HFrEF). Its potential impact on patients with AFib and heart failure with preserved ejection fraction (HFpEF), however, is less clear.
The team behind a new meta-analysis in JAMA Cardiology hoped to learn more.[1]
“It is unclear whether patients with HFpEF derive the same benefit from catheter ablation as patients with HFrEF,” wrote first author Alireza Oraii, MD, a researcher with the Population Health Research Institute, and colleagues. “This gap of knowledge is of great importance given that most foundational heart failure therapies, including beta-blockers, angiotensin receptor or neprilysin inhibitors, and mineralocorticoid receptor antagonists, that have been effective in patients with HFrEF have little or no efficacy in patients with HFpEF. To our knowledge, there is no study to date that has comprehensively summarized and compared the randomized evidence on the differential efficacy of catheter ablation on HF-related outcomes in patients with HFrEF compared with those with HFpEF.”
Oraii et al. examined data from nearly 2,500 patients who originally participated in one of 12 randomized controlled trials (RCTs). Each RCT was evaluated by multiple reviewers to search for potential signs of bias. The mean patient age was 65.3 years old, and 26.7% were women. Approximately 63% of patients presented with HFrEF, and the remaining patients presented with HFpEF.
Overall, catheter ablation was associated with a reduction in the study’s primary outcome—the composite of heart failure hospitalizations, clinically significant worsening of heart failure and unscheduled clinician visits for treatment intensification—among HFrEF patients, but not HFpEF patients.
Diving deeper, the meta-analysis revealed that a reduced risk of cardiovascular death among HFrEF patients, but not HFpEF patients. Ablation did not appear to make a significant impact on all-cause mortality for patients with HFrEF or HFpEF, the authors added.
Looking specifically at changes in left ventricular ejection fraction (LVEF), a meta-analysis of 11 studies found that ablation was linked to an improvement of 6.5% for HFrEF patients and an improvement of 2.5% for HFpEF patients.
The team’s research was associated with certain limitations, including the fact that there is limited data to date on catheter ablation among HFpEF patients. Also, incomplete data from some studies included in the meta-analysis meant researchers had to make certain categorical assumptions when grouping patients. Even with these limitations in mind, however, the group’s findings represent a significant step forward.
“This systematic review and meta-analysis found that catheter ablation for AFib was superior to conventional rate or rhythm control therapies in the reduction of heart failure events in patients with HFrEF but such benefit did not extend to patients with HFpEF,” the authors concluded. “A similar pattern was seen for cardiovascular and all-cause mortality, but this analysis was likely underpowered to demonstrate a treatment interaction. Future and ongoing well-designed, large RCTs are needed to delineate the role of catheter ablation in reducing HF-related outcomes in patients with HFpEF.”
Click here to read the full study.
An estimated two out of five AFib patients develop heart failure later in life, according to one recent analysis.
Mary joined TriMed Media in 2003. She was the founding editor and editorial director of Health Imaging, Cardiovascular Business, Molecular Imaging Insight and CMIO, now known as Clinical Innovation + Technology. Prior to TriMed, Mary was the editorial director of HealthTech Publishing Company, where she had worked since 1991. While there, she oversaw four magazines and related online media, and piloted the launch of two magazines and websites. Mary holds a master’s in journalism from Syracuse University. She lives in East Greenwich, R.I., and when not working, she is usually running around after her family, taking photos or cooking.