ArticleJournal of arrhythmia2026
Catheter Ablation Versus Medical Therapy in Atrial Fibrillation With Heart Failure With Reduced or Mildly Reduced Ejection Fraction: A GRADE-Assessed Systematic Review and Meta-Analysis.
Article in Journal of arrhythmia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
21 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Catheter ablation is an established rhythm-control strategy for atrial fibrillation (AF), but its effectiveness in patients with heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) remains incompletely defined. We performed a GRADE-assessed systematic review and meta-analysis comparing catheter ablation with conventional medical therapy in this population. Methods: PubMed, Embase, and the Cochrane Library were searched from inception to February 2026. Randomized controlled trials and observational cohort studies enrolling adults with AF and left ventricular ejection fraction (LVEF) ≤ 50% were included. Primary outcomes were all-cause mortality, cardiovascular mortality, and change in LVEF. Secondary outcomes were change in B-type natriuretic peptide (BNP) and cardiovascular hospitalization. Random-effects models were used, and certainty of evidence was assessed using GRADE. Results: Thirteen studies involving 131 492 participants were included. Catheter ablation significantly reduced all-cause mortality (RR 0.61, 95% CI 0.51-0.71) and cardiovascular mortality (RR 0.46, 95% CI 0.31-0.66), improved LVEF (MD 6.47%, 95% CI 4.47-8.47), and reduced BNP levels (MD -136.85 pg/mL, 95% CI -190.46 to -83.23). No significant reduction was observed in cardiovascular hospitalization (RR 0.78, 95% CI 0.53-1.13). Mortality benefits were consistent across subgroup analyses by study design and baseline LVEF. Conclusions: Catheter ablation was associated with lower mortality and improved cardiac function compared with medical therapy in patients with AF and HFrEF/HFmrEF. Further studies specifically evaluating HFmrEF populations are warranted.
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