Abstract 4139545: Impact of Catheter Ablation(CA) in patients with Heart failure with preserved ejection fraction(HFpEF) : A meta-analysis of RCTs

Introduction: CA has been shown to be superior to medical management in improving mortality and hospitalization in patients with heart failure with reduced ejection fraction. However, literature concerning the benefit of CA in patients with HFpEF are scarce. There have been some non-randomized clinical trials which have attempted to bridge the gap. Therefore, we conducted a systematic review and meta-analysis of RCTs focusing on the impact of catheter ablation in patients with HFpEF. Objective: To systematically review and perform a meta-analysis by comparing the outcomes of CA versus medical therapy in patients with HFpEF, focusing on all-cause mortality, cardiovascular mortality, all- cause hospitalizations and cardiovascular hospitalizations. Methods: We conducted a systematic search on PubMed, Cochrane library, Scopus database, and Web of Science using the appropriate search strategy through to April 2024. Only English original RCTs that compared CA with medical management were included for data extraction. The outcomes of interest were as follows- All-cause mortality, Cardiovascular mortality, all- cause hospitalizations and cardiovascular hospitalizations. Results: Four RCTs which included a total of 1620 patients (796 in the intervention group and 824 patients in the medical management group). Follow up duration ranged between (24 – 72 months). Improvement in Heart failure hospitalizations or events was seen in the CA group as compared with the medical management group (OR: 0.57, 95% CI 0.43-0.77, P= 0.0002). There was also a reduction in All- cause hospitalizations in the CA group with an OR of 0.67, 95% CI 0.44-0.82, p=0.005. With regards to cardiovascular mortality and all cause mortality in the CA group the OR was 0.74, 95% CI 0.40-1.35, P= 0.59 and 0.68, 95% CI 0.46-1.03, P= 0.07 respectively. These were found not to be statistically significant. Conclusion: Using CA in patients with atrial fibrillation and HFpEF showed a statistically significant reduction of heart failure hospitalizations and all cause hospitalizations. Despite the trend towards CA, cardiovascular mortality and all cause mortality were found not to be statistically significant when comparing catheter ablation and medical management. This is the largest meta-analysis in this sub-population till date. With the advent of pulsed field ablation, it will also be intriguing to see how those results contrast CA in atrial fibrillation management in patients with HFpEF.