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Heart Failure Medication Withdrawal in Patients With Improved Cardiac Function After Atrial Fibrillation Ablation:
Sitong Li1, Yidan Sun1, Yiwei Lai1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
JAMA Network Open
|June 26, 2026
Summary
Withdrawing guideline-directed medical therapy (GDMT) after atrial fibrillation (AF) ablation may lead to heart failure (HF) deterioration in some patients. Drug-related complications were more frequent when GDMT was continued, warranting further study.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Guideline-directed medical therapy (GDMT) withdrawal is common post-atrial fibrillation (AF) catheter ablation, but its safety is uncertain.
- AF-mediated cardiomyopathy recovery after ablation presents a unique scenario for evaluating GDMT de-escalation.
Purpose of the Study:
- To assess the feasibility and safety of phased GDMT withdrawal in patients with AF and suspected AF-mediated cardiomyopathy post-ablation.
- To evaluate the risk of heart failure (HF) deterioration upon reducing GDMT in this specific patient population.
Main Methods:
- An open-label pilot randomized clinical trial involving 50 patients with normalized cardiac function post-AF ablation.
- Patients were randomized 1:1 to either phased GDMT withdrawal or continuation of GDMT for 6 months.
- Primary endpoint was HF deterioration, defined by specific criteria including LVEF decline, LV dilation, elevated NT-proBNP, or worsening HF symptoms.
Main Results:
- Heart failure deterioration occurred in 13.0% of patients in the GDMT withdrawal group versus 0% in the continuation group (P=.11).
- Adverse drug events were more frequent in the GDMT continuation group (20.8%) compared to the withdrawal group (0%) (P=.050).
- No cardiovascular events were observed, and arrhythmia recurrence rates were similar between groups.
Conclusions:
- In carefully selected patients with normalized cardiac function post-AF ablation, phased GDMT withdrawal showed a trend towards increased HF deterioration.
- Continuation of GDMT was associated with a higher incidence of adverse drug events.
- Further research is needed to establish safe GDMT discontinuation protocols for patients with recovered cardiac function after AF ablation.
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