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

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    9 Citations (Scopus)


    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
    Issue number7
    Publication statusPublished - 2018

    Bibliographical note

    Publisher Copyright:
    © 2018, Japanese Circulation Society. All rights reserved.


    • Anti-arrhythmic drug
    • Atrial fibrillation
    • Catheter ablation
    • Heart failure
    • Meta-analysis

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine


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