Background: The precise relationship between atrial fibrillation (AF), which affects a significant number of individuals, and heart failure (HF) remains poorly understood. With over 12 million projected cases of AF and 8 million of HF in the United States by 2030, the need for clarity led us to conduct the first-ever umbrella review, aiming to understand the inconsistent findings regarding the efficacy of catheter ablation (CA) versus medical therapy (MT) in this population.

Methods: A comprehensive search was conducted across PubMed, Cochrane Library, and Google Scholar to identify relevant studies for inclusion in this umbrella review. The GRADE method was utilized to assess the overall certainty of the evidence thoroughly. Furthermore, the quality of the included reviews was carefully evaluated using the AMSTAR 2 and Cochrane Collaboration risk of bias tool.

Results:  After careful review, six systematic reviews and meta-analyses were selected for analysis. Notably, Catheter ablation (CA) was associated with a significant reduction in all-cause mortality (RR [95% CI]: 0.55 [0.44, 0.68], I2: 60%, p-value: <0.00001), and Heart failure (HF) hospitalization risk (RR [95% CI]: 0.61 [0.54, 0.70], I2: 0%, p-value: <0.00001), as well as a decrease in atrial fibrillation (AF) recurrence rates (RR [95% CI]: 0.36 [0.27, 0.47], I2: 0%, p-value: <0.00001). Secondary efficacy outcomes, including changes in cardiac function parameters, favored CA over MT, with significant improvements observed in Left ventricular ejection fraction (LVEF) and 6-minute walk test (6MWT).

Conclusion: AF and HF patients who received CA instead of MT had better functional outcomes and safety. The CA group has significantly lower all-cause mortality, HF hospitalization, AF recurrence, and LVEF, 6MWT, and VO2 max improvements than the MT group. Future research should include all participants with HF and AF to obtain a complete analysis.