Background: The optimal treatments for atrial fibrillation in heart failure patients are controversial. The present study compared the efficacy of catheter ablation and medical therapy in patients with atrial fibrillation and heart failure.

Methods: Pubmed, Embase, Cochrane Library, and Web of Science were searched until January 15, 2022. Randomized controlled trials comparing catheter ablation for atrial fibrillation with medical therapy in patients with atrial fibrillation and heart failure were enrolled. Primary outcome was all-cause mortality. Secondary outcomes included the heart failure hospitalization and the change in left ventricular ejection fraction, 6-minute walk test distance, peak oxygen consumption, and Minnesota Living with Heart Failure questionnaire score.

Results: Totally 8 randomized controlled trials involving 1693 patients were included. Compared with medical therapy, catheter ablation significantly reduced all-cause mortality (risk ratios = 0.60, 95% Cl: 0.45 to 0.80, P <.001) and hospitalization due to heart failure (risk ratios = 0.58, 95% Cl: 0.46 to 0.73, P <.001), improved left ventricular ejection fraction (mean difference = 5.25%, 95% CI: 2.78% to 7.71%, P <.001), improved the performance of 6-minute walk test (mean difference = 28.83 m, 95% CI: 8.61 to 49.05 m, P =.005), increased peak oxygen consumption (mean difference = 3.11 mL/kg/min, 95% CI: 1.04 to 5.18 mL/kg/min, P =.003), and reduced Minnesota Living with Heart Failure score (mean difference = −8.45, 95% CI: −16.28 to −0.62, P =.03).

Conclusion: In heart failure patients with atrial fibrillation, catheter ablation provides more benefits over medical therapy in the important clinical outcomes, exercise capacity, and quality of life.