{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:45:09Z","timestamp":1791985509355,"version":"4.4.0"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Catheter ablation is an established rhythm\u2010control 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\u2010assessed systematic review and meta\u2010analysis comparing catheter ablation with conventional medical therapy in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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) \u2264\u200950% were included. Primary outcomes were all\u2010cause mortality, cardiovascular mortality, and change in LVEF. Secondary outcomes were change in B\u2010type natriuretic peptide (BNP) and cardiovascular hospitalization. Random\u2010effects models were used, and certainty of evidence was assessed using GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirteen studies involving 131\u2009492 participants were included. Catheter ablation significantly reduced all\u2010cause mortality (RR 0.61, 95% CI 0.51\u20130.71) and cardiovascular mortality (RR 0.46, 95% CI 0.31\u20130.66), improved LVEF (MD 6.47%, 95% CI 4.47\u20138.47), and reduced BNP levels (MD \u2212136.85\u2009pg\/mL, 95% CI \u2212190.46 to \u221283.23). No significant reduction was observed in cardiovascular hospitalization (RR 0.78, 95% CI 0.53\u20131.13). Mortality benefits were consistent across subgroup analyses by study design and baseline LVEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/joa3.70464","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T07:57:34Z","timestamp":1789977454000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Catheter Ablation Versus Medical Therapy in Atrial Fibrillation With Heart Failure With Reduced or Mildly Reduced Ejection Fraction: A\n                    <scp>GRADE<\/scp>\n                    \u2010Assessed Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9191-8657","authenticated-orcid":false,"given":"Aleena Amir","family":"Malik","sequence":"first","affiliation":[{"name":"Department of Medicine United Medical and Dental College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1743-6938","authenticated-orcid":false,"given":"Nasir","family":"Saeed","sequence":"additional","affiliation":[{"name":"Department of Medicine Bacha Khan Medical College  Mardan Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2881-3620","authenticated-orcid":false,"given":"Goodluck","family":"Oparaugo","sequence":"additional","affiliation":[{"name":"Department of Public Health University of Derby  Derby UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2816-6525","authenticated-orcid":false,"given":"Muhammad Waqar","family":"Shahid","sequence":"additional","affiliation":[{"name":"Department of Medicine Khyber Medical College  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1019-0827","authenticated-orcid":false,"given":"Waqas","family":"Kareem","sequence":"additional","affiliation":[{"name":"Department of Medicine Rawalpindi Medical University  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4640-6377","authenticated-orcid":false,"given":"Fatima","family":"Yousaf","sequence":"additional","affiliation":[{"name":"Department of Medicine Khyber Medical College  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3885-4516","authenticated-orcid":false,"given":"Zain Ul","family":"Abedeen","sequence":"additional","affiliation":[{"name":"Department of Medicine Saidu Medical College  Swat Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8861-0367","authenticated-orcid":false,"given":"Fatima","family":"Sajjad","sequence":"additional","affiliation":[{"name":"Department of Medicine Khyber Medical College  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1292-8806","authenticated-orcid":false,"given":"Kashif","family":"Yousaf","sequence":"additional","affiliation":[{"name":"Department of Medicine Jalal\u2010Abad State University Named After B. Osmonov Medical Faculty  Jalal\u2010Abad Kyrgyzstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fizza","family":"Kazmi","sequence":"additional","affiliation":[{"name":"Department of Medicine Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3285-9307","authenticated-orcid":false,"given":"Rubab","family":"Zahra","sequence":"additional","affiliation":[{"name":"Department of Medicine Liaquat College of Medicine and Dentistry  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishfaq","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Medicine Ayub Medical College  Abbottabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahil","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Medicine Liaquat National Medical College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanzeela","family":"Gul","sequence":"additional","affiliation":[{"name":"Department of Medicine Saidu College of Dentistry  Swat Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zartasha","family":"Rahim","sequence":"additional","affiliation":[{"name":"Department of Medicine Quaid\u2010e\u2010Azam Medical College  Bahawalpur Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9163-4425","authenticated-orcid":false,"given":"Abdul","family":"Basit","sequence":"additional","affiliation":[{"name":"Department of Medicine Gomal Medical College  D.I. 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