title: Efficacy and safety of catheter ablation vs. rate control of atrial fibrillation in systolic left ventricular dysfunction : A meta-analysis and systematic review.
abstract: OBJECTIVE
  It is unclear what constitutes the optimal strategy for management of atrial fibrillation (AF) in patients with systolic left ventricular (LV) dysfunction. We hypothesized that catheter ablation of AF had benefits compared with rate control in patients with systolic LV dysfunction.
  
  
  METHODS
  PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials and nonrandomized, observational studies. Weighted mean differences (WMD) and 95 % confidence intervals (CIs) were calculated to compare the improvement of left ventricular ejection fraction (LVEF), functional capacity, and quality of life between a catheter ablation group and a rate control group.
  
  
  RESULTS
  Six trials with 324 patients were included in the analysis. Patients in the catheter ablation group had greater improvement of LVEF (WMD: 8.89; 95 % CI: 6.93-10.86; p < 0.001), 6-min walk distance (WMD: 46.9; 95 % CI: 28.5-65.4; p < 0.001), and lower Minnesota Living With Heart Failure Questionnaire (MLHFQ) scores (WMD: - 19.6; 95 % CI: - 23.6-- 15.7; p < 0.001) compared with patients in the rate control group. Overall, there were only ten procedure-related events and the procedure-related events rate was 4.9 % per procedure and 5.6 % per patient.
  
  
  CONCLUSIONS
  The present analysis suggests that catheter ablation of AF has benefits in terms of an improvement in LVEF, in functional capacity, and in quality of life compared with rate control in patients with systolic LV dysfunction, and the risk of complications related to procedures is acceptable.
authors.affiliation: Department of Cardiology, People's Hospital of Jiangsu University, 8 Dianli Road, 212002, Zhenjiang, Jiangsu, China.
authors.forename: B
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, People's Hospital of Jiangsu University, 8 Dianli Road, 212002, Zhenjiang, Jiangsu, China.
authors.forename: D
authors.initials: D
authors.lastname: Shen
authors.affiliation: Department of Nephrology, People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
authors.forename: S
authors.initials: S
authors.lastname: Feng
authors.affiliation: Department of Cardiology, People's Hospital of Jiangsu University, 8 Dianli Road, 212002, Zhenjiang, Jiangsu, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhen
authors.affiliation: Department of Cardiology, People's Hospital of Jiangsu University, 8 Dianli Road, 212002, Zhenjiang, Jiangsu, China. guohuizhang2013@126.com.
authors.forename: G
authors.initials: G
authors.lastname: Zhang
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D017115:Catheter Ablation / Q000523:psychology / Q000706:statistics & numerical data*; D015897:Comorbidity; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D019317:Evidence-Based Medicine; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Atrial fibrillation; Catheter ablation; Meta-analysis; Rate control; Systolic left ventricular dysfunction