Effects Of Radiofrequency Catheter Ablation On Left Ventricular Structure And Function In Patients With Atrial Fibrillation:a Meta-Analysis

INTRODUCTION:Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice with an increasing prevalence with advancing age. AF is associated with significant mortality, and hospital cost burden, resulting from co-morbid events such as heart failure, stroke and other embolic complications. Radiofrequency catheter ablation (RFCA) is an effective therapy for AF. The efforts of previous studies mainly concentrated on the effects of RFCA on left atrial structure and function. However, the effects of RFC A require further discussion.OBJECTIVE:This study was designed to investigate the effects of RFCA on LV structure and function in AF patients.METHODS:A systematic literature search in MEDLINE, EMBASE, and Cochrane Controlled Trials Register was performed to identify trials in English language, conducting with the term:(catheter ablation) AND (atrial fibrillation) AND ((cardiac function) OR (ventricular function) OR (heart function) OR (ventricular size) OR (ventricular volume)). Effect size was expressed as weighted mean difference (WMD) with95%confidence interval (CI). LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV) and LV ejection fraction (LVEF) were estimated. A pooled effect was calculated using a random-effects model to take into account within-study and between-study variance. Heterogeneity was assessed with the use of the Q statistic and the I2statistic. The effects of RFCA on LVEF was further investigated in two subgroup analyses, one to access the effects in patients with low (<50%) and normal LVEF (≥50%), the second to analyze the effects in patients with paroxysmal and chronic AF. Meta-regression analysis was performed to evaluate the impact of follow-up on the improvement of LVEF. Sensitivity analysis was performed to explore the heterogeneity.RESULTS:A total of21trials including1135participants were qualified for this meta-analysis. Compared to the baseline values, there were significant decreases in LVEDV (WMD,-6.39ml;95%CI,-12.46to-0.33) and LVESV (WMD,-6.39ml;95%CI,-11.35to-1.42), and significant improvement in LVEF (WMD,6.23%;95%CI,3.70to8.75), but no significant changes were observed in LVEDD (WMD,-0.64mm;95%CI,-2.40to1.13) and LVESD (WMD,-0.38mm;95%CI,-1.32to0.56) after RFCA. Subgroup analysis demonstrated that patients with low LVEF (WMD,11.90%;95%CI,9.16to14.64) gained more benefits than those with normal LVEF (WMD,1.56%;95%CI,0.38to2.74). Besides, patients with chronic AF (WMD,10.96%;95%CI,4.92to17.01) improved more than those with paroxysmal AF (WMD,1.93%;95%CI,-0.27to4.12).CONCLUSION:RFCA in AF patients could reverse LV structural remodeling and improve LV systolic function, especially in patients with low LVEF and chronic AF.