Randomized Ablation-Based Rhythm-Control Versus Rate-Control Trial in Patients With Heart Failure and Atrial...

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• Atrial fibrillation (AF) and heart failure (HF) frequently coexist, presenting complex treatment challenges.
• Pharmacological rhythm control for AF has not demonstrated superiority over rate control.
• This study investigated if ablation-based rhythm control improves outcomes in HF patients with AF.

Purpose of the Study:

• To compare the efficacy of ablation-based rhythm control versus rate control in patients with coexisting AF and HF.
• To evaluate the impact on clinical outcomes, including mortality and HF events.
• To assess secondary outcomes such as cardiac function and quality of life.

Main Methods:

• A multicenter, open-label trial with blinded outcome evaluation.
• 411 patients with high-burden AF, NYHA class II-III HF, and elevated NT-proBNP were randomized.
• Primary outcome: composite of all-cause mortality and HF events. Minimum 2-year follow-up.

Main Results:

• No statistically significant difference in the primary outcome between ablation (23.4%) and rate control (32.5%) groups (HR 0.71; P=0.066).
• Ablation group showed significant improvements in LVEF, 6-minute walk distance, and NT-proBNP levels.
• Greater improvements in quality of life were observed in the ablation group (MLWHFQ, AFEQLI scores).

Conclusions:

• Ablation-based rhythm control did not significantly reduce mortality or HF events compared to rate control in this patient population.
• A nonsignificant trend favored ablation for improved outcomes.
• Significant improvements in cardiac function and quality of life suggest potential benefits of ablation despite lack of statistical significance in primary endpoint.