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KMID : 1812720210030030179
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International Journal of Heart Failure
2021 Volume.3 No. 3 p.179 ~ p.193
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Rhythm Control of Persistent Atrial Fibrillation in Systolic Heart Failure: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
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Khanra Dibbendhu
Deshpande Saurabh
Mukherjee Anindya
Mohan Siddhratha
Khan Hassan
Kathuria Sanjeev
Kella Danesh
Padmanabhan Deepak
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Abstract
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Background and Objectives: Persistent atrial fibrillation (PeAF) with heart failure (HF) arguably constitutes the sickest subset of atrial fibrillation (AF) patients.
Methods: A systematic search was made in PubMed, Embase, and Scopus databases. Network meta-analysis (NMA) of PeAF patients with systolic HF comparing all-cause mortality, change in HF-related quality of life (QoL) and hospitalization due to heart failure (HHF) were performed among catheter ablation (CA) of AF, rate-controlling drugs (RCDs), anti-arrhythmic drugs (AADs), and atrio-ventricular nodal ablation (AVNA) using Bayesian random effect model.
Results: Ablation strategies resulted significantly lower mortality than medical therapies (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.35 to 0.76). CA of AF was associated with lower trend of mortality (OR, 0.78; 95% credible interval [CrI], 0.08 to 7.63) in comparison to AVNA in the Bayesian NMA. Rhythm control strategies resulted significantly higher improvement of QoL than rate control strategies (mean difference [MD], ?12.78; 95% CI, ?21.26 to ?4.31). Bayesian NMA showed that CA of AF was better than AAD (MD, ?7.98; 95% CrI, ?27.68 to 8.27), however ranked AVNA to be lowest. Ablation strategies provided significantly lower HHF than medical therapies (OR, 0.42; 95% CI, 0.30 to 0.58). Bayesian NMA showed that CA of AF performed not only better than AAD (OR, 0.33; 95% CrI, 0.09 to 1.3) to reduce HHF, but also than AVNA (OR, 0.20; 95% CrI, 0.00 to 4.76). Of note, RCD ranked lowest with regard to mortality and HHF.
Conclusions: CA of AF remains the best strategy even for the sickest group of PeAF patients with systolic HF in regards to all-cause mortality, HF-related QoL and HHF.
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KEYWORD
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Persistent atrial fibrillation, Heart failure, Catheter ablation
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