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Background <p>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.</p> Objective <p>This meta-analysis evaluated the effect of AF ablation on primary prevention ICD eligibility in patients with left ventricular ejection fraction (LVEF) ≤ 35%.</p> Methods <p>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).</p> Results <p>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&#xa0;months (IQR: 6.0 – 15.0) the pooled proportion of patients with LVEF &gt; 35% was 72.1% (95% CI, 63.0–80.3; I<sup>2</sup> = 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, <i>p</i> &lt; 0.001, I<sup>2</sup> = 16.9%). Ischemic etiology was negatively associated with LVEF improvement beyond 35% (β = -40.4%, 95% CI -86.2 – -3.4; <i>p</i> = 0.007). Longitudinal meta-analysis revealed an estimated 5.3&#xa0;months needed to surpass the 35% threshold.</p> Conclusion <p>AF ablation leads to LVEF recovery &gt; 35% in the majority of HFrEF patients within 6&#xa0;months, particularly in non-ischemic etiologies, potentially impacting prophylactic ICD decision-making.</p> Graphical Abstract <p>● Key Question: Does AF catheter ablation influence primary prevention ICD eligibility in patients with HFrEF and LVEF ≤ 35%?</p> <p>● Key Finding: AF ablation may lead to LVEF recovery &gt; 35% in approximately 50–70% of HFrEF patients during follow-up, particularly in non-ischemic etiologies.</p> <p>Take-home Message: AF ablation may significantly alter primary prevention ICD eligibility in the majority of HFrEF patients.</p> <p>AF, atrial fibrillation; ICD, implantable cardioverter defibrillator; HFrEF, heart failure with reduced ejection fraction; LVEF, left ventricular ejection fraction; HR, heart rate; SHD, structural heart disease; GDMT, guideline-directed medical therapy; HF, heart failure.</p> <p></p>

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Impact of atrial fibrillation catheter ablation on primary prevention ICD eligibility in heart failure with reduced ejection fraction: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年3月30日

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  • Federico Landra,
  • Emanuele Curti,
  • Giulio Falasconi,
  • Diego Penela,
  • Marco Bergonti,
  • Andrea Saglietto,
  • Karim Benali,
  • Alessia Chiara Latini,
  • Dario Turturiello,
  • David Soto-Iglesias,
  • Amato Santoro,
  • Erika Taravelli,
  • Andrea Rossi,
  • Julio Martí-Almor,
  • Giulio Conte,
  • Matteo Anselmino,
  • Kevin Vernooy,
  • Antonio Berruezo

摘要

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 < 0.001, I2 = 16.9%). Ischemic etiology was negatively associated with LVEF improvement beyond 35% (β = -40.4%, 95% CI -86.2 – -3.4; p = 0.007). Longitudinal meta-analysis revealed an estimated 5.3 months needed to surpass the 35% threshold.

Conclusion

AF ablation leads to LVEF recovery > 35% in the majority of HFrEF patients within 6 months, particularly in non-ischemic etiologies, potentially impacting prophylactic ICD decision-making.

Graphical Abstract

● Key Question: Does AF catheter ablation influence primary prevention ICD eligibility in patients with HFrEF and LVEF ≤ 35%?

● Key Finding: AF ablation may lead to LVEF recovery > 35% in approximately 50–70% of HFrEF patients during follow-up, particularly in non-ischemic etiologies.

Take-home Message: AF ablation may significantly alter primary prevention ICD eligibility in the majority of HFrEF patients.

AF, atrial fibrillation; ICD, implantable cardioverter defibrillator; HFrEF, heart failure with reduced ejection fraction; LVEF, left ventricular ejection fraction; HR, heart rate; SHD, structural heart disease; GDMT, guideline-directed medical therapy; HF, heart failure.