title: Pulmonary Vein Isolation Compared to Rate Control in Patients with Atrial Fibrillation: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Atrial fibrillation (AF) often coexists with congestive cardiac failure (CCF), with multiple treatment options available.
  
  
  METHODS
  Systematic review and meta-analysis of randomised control trials (RCT) comparing pulmonary vein isolation (PVI), pharmacological rate control, and atrioventricular junction ablation with pacemaker insertion (AVJAP) for AF, with a subgroup analysis in patients with CCF. We analysed changes in left ventricular ejection fraction (LVEF), Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, six-minute walk distance (6MWD), treadmill exercise time, and treatment complications. Results were expressed as weighted mean differences (WMD) with 95% Confidence-Intervals (95%CI).
  
  
  RESULTS
  We included seven RCT (425 participants). PVI was associated with a greater increase in LVEF (WMD+6.5%, 95%CI:+0.6to+12.5) and decrease in MLHFQ score (WMD-11.0, 95%CI:-2.6to-19.4) than pharmacological rate control in patients with CCF. PVI was also associated with a greater increase in LVEF (WMD+9.0%, 95%CI:+6.3to+11.7) and 6MWD (WMD+55.0metres, 95%CI:+34.9to+75.1), and decrease in MLHFQ score (WMD-22.0, 95%CI:-17.0to-27.0), compared to AVJAP in patients with CCF. Irrespective of cardiac function, pharmacological rate control had similar effects to AVJAP on LVEF (WMD+0.6%, 95%CI:-8.3to+9.4) and treadmill exercise time (WMD+0.5minutes, 95%CI:-0.4to+1.3).
  
  
  CONCLUSIONS
  Our results support the clinical implementation of PVI over AVJAP or pharmacological rate control in AF patients with CCF, who may or may not have already trialled pharmacological rhythm control.
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Kaivan
authors.initials: K
authors.lastname: Vaidya
authors.affiliation: Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Clare
authors.initials: C
authors.lastname: Arnott
authors.affiliation: Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Russell
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Masson
authors.affiliation: Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Sy
authors.affiliation: Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Heart Research Institute, Sydney, NSW, Australia. Electronic address: sanjay.patel@hri.org.au.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Patel
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D011667:Pulmonary Veins; D016032:Randomized Controlled Trials as Topic
keywords: Atrial fibrillation; Atrioventricular node; Catheter ablation; Congestive heart failure; Heart rate control; Pulmonary vein isolation