title: Catheter ablation versus medical rate control for persistent atrial fibrillation in patients with heart failure: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The effectiveness of restoring the sinus rhythm by catheter ablation relative to that of medical rate control for persistent atrial fibrillation (AF) patients with heart failure (HF) remains to be defined.
  
  
  METHODS
  We systematically searched Embase, Pubmed, the Cochrane Library, and ClinicalTrials.gov for articles that compared the outcomes of interest between catheter ablation and medical rate control therapy in persistent AF patients with HF and left ventricular systolic dysfunction (LVSD). The primary endpoint was the change in the left ventricular ejection fraction (LVEF) following catheter ablation or medical rate control therapy relative to baseline. Other endpoints included changes in cardiac function and exercise capacity, including the New York Heart Association (NYHA) class, the brain natriuretic peptide (BNP) level, the peak oxygen consumption (peak VO2), the 6-minute walk test (6MWT) results, and quality of life (QOL).
  
  
  RESULTS
  Three randomized controlled trials (RCTs) with 143 patients were included. At the overall term follow-up, catheter ablation significantly improved the LVEF (mean difference [MD]: 6.22%; 95% confidence interval [CI]: 0.7-11.74, P = 0.03) and peak VO2 (MD: 2.81 mL/kg/min; 95% CI: 0.78-4.85, P = 0.007) and reduced the NYHA class (MD: 0.9; 95% CI: 0.59-1.21, P < 0.001) and the Minnesota Living with Heart Failure Questionnaires (MLHFQ) scores (MD: -11.05; 95% CI: -19.45 - -2.66, P = 0.01) compared with the medical rate control for persistent AF patients with HF. Alterations in parameters, such as the BNP level, 6MWT, and Short Form-36 (SF-36) questionnaire scores also revealed trends that favored catheter ablation therapy, although these differences were not significant.
  
  
  CONCLUSIONS
  Catheter ablation resulted in improved LVEF, cardiac function, exercise capacity, and QOL for persistent AF patients with HF compared with the medical rate control strategy.
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhu
authors.forename: Xinbin
authors.initials: X
authors.lastname: Zhou
authors.forename: Hongwen
authors.initials: H
authors.lastname: Cai
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Wang
authors.forename: Huimin
authors.initials: H
authors.lastname: Xu
authors.forename: Shenjie
authors.initials: S
authors.lastname: Chen
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Xu
authors.forename: Haibin
authors.initials: H
authors.lastname: Xu
authors.forename: Wei
authors.initials: W
authors.lastname: Mao
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D061214:Patient Safety; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents