Atrial fibrillation catheter ablation led to LVEF recovery >35% in 72.1% (95% CI 63.0-80.3) of HFrEF patients, with an estimated 5.3 months needed to surpass the threshold.
Meta-Analysis (n=913)
Does atrial fibrillation catheter ablation improve LVEF to >35% in patients with HFrEF and AF?
Atrial fibrillation catheter ablation leads to LVEF recovery >35% in the majority of HFrEF patients within 6 months, which may impact decision-making for primary prevention ICD implantation.
Effect estimate: Pooled proportion 72.1% (95% CI 63.0-80.3)
BACKGROUND: Patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) may show positive remodeling after catheter ablation, yet rhythm control is not consistently prioritized alongside guideline-directed medical therapy (GDMT) before implantable cardioverter-defibrillator (ICD) implantation. OBJECTIVE: This meta-analysis evaluated the effect of AF ablation on primary prevention ICD eligibility in patients with left ventricular ejection fraction (LVEF) ≤ 35%. METHODS: PubMed/MEDLINE, Scopus and Cochrane databases were searched until April 2025 for studies including patients with LVEF ≤ 35% undergoing AF catheter ablation and reporting outcomes regarding LVEF evolution during follow-up (PROSPERO CRD420251028456). RESULTS: Twenty-two studies, of which six randomized controlled trials and 16 observation studies, comprising 913 patients, were included. At a median follow-up of 11.4 months (IQR: 6.0 – 15.0) the pooled proportion of patients with LVEF > 35% was 72.1% (95% CI, 63.0–80.3; I2 = 84.8%). Subgroup analysis of studies including only patients with structural heart disease on contemporary GDMT showed a pooled proportion of 62.7% (95% CI 52.0 – 72.8, p 35% in the majority of HFrEF patients within 6 months, particularly in non-ischemic etiologies, potentially impacting prophylactic ICD decision-making.
Landra et al. (Mon,) conducted a meta-analysis in Heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) (n=913). Atrial fibrillation catheter ablation was evaluated on Proportion of patients with LVEF > 35% (Pooled proportion 72.1%, 95% CI 63.0-80.3). Atrial fibrillation catheter ablation led to LVEF recovery >35% in 72.1% (95% CI 63.0-80.3) of HFrEF patients, with an estimated 5.3 months needed to surpass the threshold.
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