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Introduction: Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) patients with heart failure (HF) undergoing catheter ablation (CA) as compared to medical therapy. We sought to investigate the benefit of CA on outcomes of patients with AF and HF as compared to medical therapy. Methods and Results: A systematic review of PubMed, Embase, and Cochrane Central Register of Clinical Trials was performed for clinical studies evaluating the benefit of CA for patients with AF and HF. Primary endpoint was all‐cause mortality. Secondary endpoints included atrial‐arrhythmia recurrence and improvement in left ventricular ejection fraction (LVEF). Eight randomized controlled trials were included with a total of 2121 patients (mean age: 65 ± 5 years; 72% male). Mean follow‐up duration was 32.9 ± 14.5 months. All‐cause mortality in patients who underwent CA was significantly lower than in the medical treatment group (8.8% vs. 13.5%, RR 0.65, 95% confidence interval [CI] 0.51−0.83, p =.0005). A 35% relative risk reduction and 4.7% absolute risk reduction in all‐cause mortality was observed with CA. Rates of all‐atrial arrhythmia recurrence were significantly lower in the CA group (39.9% vs. 69.6%, RR: 0.55, 95% CI: 0.40−0.76, p =.0003). Improvement in LVEF was significantly higher in patients undergoing CA (+9.4 ± 7.6%) as compared to conventional treatment (+3.3 ± 8%) (mean difference 6.2, 95% CI: 3.6−8.8, p <.00001). Conclusion: CA for AF in patients with HF decreases all‐cause mortality, improves all‐atrial arrhythmia recurrence rate and LVEF when compared to medical management. CA should be considered the treatment of choice to improve survival in this select group of patients. Nonetheless, the benefit of CA in patients with severely reduced ejection fraction and New York Heart Association class IV HF has not been clearly elucidated. [ABSTRACT FROM AUTHOR]

Introduction: Empirical pulmonary vein isolation (PVI) remains the cornerstone for catheter ablation of atrial fibrillation (AF). Various ablation strategies and modalities are continually tested with the aim of improving ablation outcomes. Although focal impulse and rotor modulation (FIRM)‐guided ablation is currently used as an adjunct to PVI, evidence supporting this strategy is conflicting. We sought to examine whether the utilization of FIRM‐guided ablation with or without PVI is associated with a decrease in all‐atrial arrhythmia recurrence as compared to PVI alone. Methods: A systematic review of PubMed, Cochrane, and Embase was performed for head‐to‐head study designs comparing outcomes of patients who underwent FIRM‐guided ablation with or without PVI to those who underwent PVI alone. The primary efficacy endpoint was all‐atrial arrhythmia recurrence. The secondary endpoints were complications rates and procedural characteristics. Results: Overall, six studies comprising 674 patients undergoing either FIRM‐guided ablation ± PVI versus PVI were included (mean age 63.4 ± 9.2, male 74%, 9% paroxysmal AF, 91% nonparoxysmal AF). After a mean follow‐up of 18.8 months, FIRM‐guided ablation with or without PVI was not associated with improvement in all‐atrial arrhythmia recurrence rate compared to PVI alone (43.4% vs. 45.9%, risk ratio [RR]: 1.06; 95% confidence interval [CI]: 0.77–1.47; p =.70). No statistically significant difference was noted in complication rates between the two groups (RR: 1.66; 95% CI: 0.08–34.54; p =.74). Conclusion: In this meta‐analysis of head‐to‐head comparison studies, FIRM‐guided ablation with or without PVI did not provide any benefit in improving all‐atrial arrhythmia recurrence at follow‐up when compared to PVI alone. [ABSTRACT FROM AUTHOR]

Background: Pulmonary vein isolation (PVI) is the mainstay of catheter ablation (CA) for paroxysmal atrial fibrillation (AF). However, for persistent and long‐standing persistent AF, there are no established strategies to improve the success rate of CA. Despite studies indicating that prophylactic cavotricuspid isthmus (CTI) ablation provides no or limited incremental benefit in patients with AF, it is still routinely performed worldwide. Objective: We sought to examine whether CTI ablation for AF is associated with improvement in recurrence of all‐atrial arrhythmias, compared with PVI alone in patients with and without typical atrial flutter (AFL). Methods: A systematic review of PubMed, Cochrane, and Embase was performed for clinical studies including AF patients, reporting outcomes of CTI + PVI versus PVI alone. The primary efficacy endpoint was recurrence of all‐atrial arrhythmias. Results: Five studies comprising 1400 patients undergoing CTI + PVI versus PVI alone were included; 1110 patients had AF without AFL, and 290 patients had coexistent AF and AFL. After a mean follow‐up of 14.4 ± 4.8 months, CTI + PVI was not associated with improvement in recurrence of all‐atrial arrhythmias when compared with PVI alone (risk ratio [RR]: 1.29; 95% confidence interval [CI]: 0.93–1.79;p =.13). In the subgroup analysis, there were no differences between both groups in patients with AF without AFL (RR: 1.55; 95% CI: 0.96–2.48; p =.07), and in patients with AF and AFL (RR: 0.91; 95% CI: 0.6–1.39; p =.68). Conclusion: In AF patients, irrespective of the presence of typical AFL, additional CTI ablation is not associated with improvement in recurrence of all‐atrial arrhythmias, compared with PVI alone. [ABSTRACT FROM AUTHOR]

Background: The pathologic process of ARVC (arrhythmogenic right ventricular cardiomyopathy) typically originates in the epicardium or subepicardial layers with progression toward endocardium. However, in the most recent ARVC international task force consensus statement, epicardial ventricular tachycardia (VT) ablation is recommended as a Class I indication only in patients with at least one failed endocardial VT ablation attempt. Objective: The aim of this meta‐analysis is to assess the outcomes of ARVC patients undergoing combined endo‐epicardial VT ablation, as compared to endocardial ablation alone. Methods: A systematic review of PubMed, Embase, and Cochrane was performed for studies reporting clinical outcomes of endo‐epicardial VT ablation vs endocardial‐only VT ablation in patients with ARVC. Fixed‐Effect model was used if I2 < 25 and the Random‐Effects Model was used if I2 ≥ 25%. Results: Nine studies consisting of 452 patients were included (mean age 42.3 ± 5.7 years; 70% male). After a mean follow‐up of 48.1 ± 21.5 months, endo‐epicardial ablation was associated with 42% relative risk reduction in VA recurrence as opposed to endocardial ablation alone (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.45‐0.75; P <.0001). No significant differences were noted between endo‐epicardial and endocardial VT ablation groups in terms of all‐cause mortality (RR, 1.19; 95% CI, 0.03‐47.08; P =.93) and acute procedural complications (RR, 5.39; 95% CI, 0.60‐48.74; P =.13). Conclusions: Our findings suggest that in patients with ARVC, endo‐epicardial VT ablation is associated with a significant reduction in VA recurrence as opposed to endocardial ablation alone, without a significant difference in all‐cause mortality or acute procedural complications. [ABSTRACT FROM AUTHOR]