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Pulmonary Vein Isolation Only for Atrial Fibrillation With Heart Failure (POLAR-HF).
Andreas A Boehmer1, Moritz Rothe2, Jason G Andrade3
1Department of Cardiology, St. Josefs-Hospital Wiesbaden, Wiesbaden Germany; Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Ontario, Canada.
JACC. Clinical Electrophysiology
|November 20, 2025
Summary
Pulmonary vein isolation (PVI)-only cryoballoon ablation is effective for atrial fibrillation (AF) rhythm control in heart failure with reduced ejection fraction (HFrEF) patients. This PVI-only strategy demonstrated comparable efficacy and safety to patients without HFrEF.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) significantly increase patient morbidity and mortality.
- Ablation, especially radiofrequency ablation, offers clinical benefits for rhythm control in AF.
- Limited prospective data exist on pulmonary vein isolation (PVI)-only strategies in HFrEF patients, and direct comparisons with non-HFrEF populations are lacking.
Purpose of the Study:
- To evaluate if a PVI-only cryoballoon ablation strategy is noninferior for rhythm control in HFrEF patients (LVEF ≤40%) compared to non-HFrEF patients.
- To assess and compare the safety outcomes of PVI-only ablation in both HFrEF and non-HFrEF patient groups.
Main Methods:
- A prospective, single-center, noninferiority observational study was conducted.
- Propensity score matching was used to analyze 1,044 patients (174 HFrEF, 870 non-HFrEF) from a total of 1,420 AF patients undergoing PVI.
- The primary efficacy endpoint was atrial arrhythmia recurrence post-90-day blanking period; safety endpoints included mortality and cerebrovascular events.
Main Results:
- The PVI-only approach demonstrated noninferior rhythm control efficacy in HFrEF patients (43.7%) versus non-HFrEF patients (43.6%) at 2-year follow-up (P < 0.001 for noninferiority).
- All-cause mortality was numerically higher in the HFrEF group (6.3% vs. 3.4%), though not statistically significant (P=0.07).
- Procedural safety event rates were comparable between the HFrEF and non-HFrEF groups (2.9% vs. 4.1%; P=0.53).
Conclusions:
- A PVI-only cryoballoon ablation strategy provides noninferior rhythm control efficacy for atrial fibrillation in patients with HFrEF compared to those without.
- The procedural safety of PVI-only ablation is comparable between HFrEF and non-HFrEF patients.
- These findings support the use of PVI-only ablation in AF patients with HFrEF.
