Surgical ablation in patients with atrial fibrillation and left ventricular dysfunction: a systematic review and meta-analysis
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Atrial fibrillation (AF) and left ventricular dysfunction (LVD) are common conditions that often coexist, with about 25% of patients in NYHA classes I-II having AF. Efficacy and safety of surgical ablation (SA) in this population remains unclear.
Methods
We aimed to perform a single-arm meta-analysis to assess the outcomes of standalone and concomitant SA in adult patients with AF and LVD. We searched PubMed, Scopus and the Cochrane Library. Endpoints of interest were maintenance of sinus rhythm, freedom from anti-arrhythmic drug (AAD) use, change in LVEF, 30-day mortality, 1 year mortality and major procedural complications. We calculated pooled proportions or means for binary and continuous endpoints, respectively, with a 95 % confidence interval (CI).
Results
Ten observational studies comprising 863 patients (mean follow-up of 19 months) were included. At 1 year, SA resulted in a sinus rhythm rate of 83.9 % (95 % CI: 69.5–92.3); freedom from AAD use of 81.6 % (95 % CI: 64.7–91.7); and mortality of 5.77 (95 % CI:3.7–8.9). 30-day mortality was 2.16 % (95 % CI: 0.9–4.9); major complications 16.73 % (95 % CI: 12–23); and an improvement in LVEF of 12 % (95 % CI: 9–17).
Conclusion
This meta-analysis found that SA appears to be an effective strategy to achieve sinus rhythm in patients with AF and LVD, with a pooled 30-day mortality of 2.2%. Comparative studies are warranted to evaluate the relative safety and efficacy of SA compared with other rhythm control strategies in this population.
Atrial fibrillation (AF) and left ventricular dysfunction (LVD) are common conditions that often coexist, with about 25% of patients in NYHA classes I-II having AF. Efficacy and safety of surgical ablation (SA) in this population remains unclear.
Methods
We aimed to perform a single-arm meta-analysis to assess the outcomes of standalone and concomitant SA in adult patients with AF and LVD. We searched PubMed, Scopus and the Cochrane Library. Endpoints of interest were maintenance of sinus rhythm, freedom from anti-arrhythmic drug (AAD) use, change in LVEF, 30-day mortality, 1 year mortality and major procedural complications. We calculated pooled proportions or means for binary and continuous endpoints, respectively, with a 95 % confidence interval (CI).
Results
Ten observational studies comprising 863 patients (mean follow-up of 19 months) were included. At 1 year, SA resulted in a sinus rhythm rate of 83.9 % (95 % CI: 69.5–92.3); freedom from AAD use of 81.6 % (95 % CI: 64.7–91.7); and mortality of 5.77 (95 % CI:3.7–8.9). 30-day mortality was 2.16 % (95 % CI: 0.9–4.9); major complications 16.73 % (95 % CI: 12–23); and an improvement in LVEF of 12 % (95 % CI: 9–17).
Conclusion
This meta-analysis found that SA appears to be an effective strategy to achieve sinus rhythm in patients with AF and LVD, with a pooled 30-day mortality of 2.2%. Comparative studies are warranted to evaluate the relative safety and efficacy of SA compared with other rhythm control strategies in this population.
Date Issued
2025-06-01
Date Acceptance
2025-03-09
Citation
International Journal of Cardiology: Heart & Vasculature, 2025, 58
ISSN
2352-9067
Publisher
Elsevier
Journal / Book Title
International Journal of Cardiology: Heart & Vasculature
Volume
58
Copyright Statement
© 2025 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
10.1016/j.ijcha.2025.101648
Publication Status
Published
Article Number
101648
Date Publish Online
2025-03-15