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Updated: May 31, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Convergent Hybrid Ablation Versus Catheter Ablation in Patients With Persistent Atrial Fibrillation and Heart
Omar Ahmed1, Elijah R Behr1,2, Sarah White1
1Cardiovascular and Genomics Research Institute,School of Health and Medical Sciences City St George's, University of London Cranmer Terrace London SW17 0RE UK.
Insights
Hybrid ablation offers a promising approach for managing persistent atrial fibrillation (AF) in heart failure patients. This trial investigates its effectiveness compared to catheter ablation for improved rhythm control.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Persistent atrial fibrillation (AF) combined with heart failure with reduced ejection fraction (HFrEF) significantly increases morbidity and mortality.
- Current catheter ablation techniques for persistent AF in HFrEF patients yield suboptimal outcomes.
- Convergent hybrid ablation, integrating epicardial and endocardial approaches, shows potential for more durable rhythm control.
Purpose of the Study:
- To compare the efficacy and safety of convergent hybrid ablation versus catheter ablation for persistent AF in patients with HFrEF.
- To address the lack of randomized data comparing ablation strategies in this high-risk population.
Main Methods:
- The HALT AF trial is a multicenter, prospective, randomized controlled trial.
- 120 patients with nonparoxysmal AF and LVEF <50% will be randomized to hybrid or catheter ablation.
- The primary efficacy endpoint is freedom from recurrent arrhythmia at 12 months off antiarrhythmic drugs, post-ablation.
Main Results:
- This section is not yet available as the study is ongoing.
- The primary safety endpoint is major adverse cardiovascular events within 30 days.
- Secondary endpoints include assessments of cardiac remodeling, biomarkers, symptoms, and quality of life.
Conclusions:
- HALT AF is the first randomized trial comparing convergent hybrid and catheter ablation in persistent AF with reduced LVEF.
- The study aims to provide crucial evidence for rhythm control strategies in this underrepresented, high-risk group.
- Findings will inform guideline recommendations for managing AF in HFrEF patients.
Background:
The coexistence of persistent atrial fibrillation (AF) and heart failure with reduced left ventricular ejection fraction is associated with greater morbidity and death than either condition alone. Catheter ablation improves outcomes in selected patients, yet results in persistent AF remain unsatisfactory. Convergent hybrid ablation may offer more durable rhythm control by integrating epicardial and endocardial techniques to achieve homogeneous, transmural pulmonary vein and posterior wall isolation. However, randomized data comparing ablation strategies in patients with reduced left ventricular ejection fraction are lacking, leaving a critical evidence gap.
Methods:
HALT AF (Hybrid Ablation for Atrial Fibrillation With Heart Failure) is an investigator-initiated, multicenter, prospective, open-label, randomized controlled trial with blinded outcome assessment. A total of 120 patients with nonparoxysmal AF, left ventricular ejection fraction <50%, and at least moderate left atrial dilatation undergoing first-time ablation will be randomized 1:1 to hybrid ablation or catheter ablation. All patients will receive preablation guideline-directed optimization and undergo strategically equivalent ablation (pulmonary vein isolation plus posterior wall isolation). The primary efficacy end point is freedom from recurrent arrhythmia >30 seconds at 12 months and off class I/III antiarrhythmic drugs, excluding a 3-month blanking period. The primary safety end point is major adverse cardiovascular events within 30 days. Secondary end points assess cardiac remodeling, biomarkers, symptoms, and quality of life.
Conclusions:
HALT AF will be the first randomized trial to compare convergent hybrid ablation and catheter ablation in patients with persistent AF and reduced left ventricular function. By enrolling only patients with reduced left ventricular ejection fraction and dilated atria and by equating lesion sets, HALT AF is designed to provide critical evidence to inform rhythm-control strategies and guideline recommendations in this high-risk, underrepresented population.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT05411614.
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