- Question
- Does atrioventricular junction ablation plus cardiac resynchronization (Ablation + CRT) reduce all-cause mortality compared with pharmacological rate control in patients with permanent atrial fibrillation, narrow QRS and a prior heart failure hospitalization?
- Design
- International, randomized, open-label trial with blinded outcome assessment, enrolling 133 patients. It was stopped for efficacy at an interim analysis, after a median follow-up of 29 months per patient.
- Population
- Patients with severely symptomatic permanent atrial fibrillation for more than 6 months, narrow QRS (≤110 ms) and at least one heart failure hospitalization in the previous year. Mean age was 73 ± 10 years and 62 (47%) were women.
- Intervention
- Atrioventricular junction ablation plus implantation of a biventricular pacemaker (cardiac resynchronization), together with optimized drug therapy.
- Control
- Pharmacological rate control, with an implantable defibrillator according to guidelines.
- Primary outcome
- All-cause mortality.
- Results
- The primary endpoint occurred in 7 patients (11%) in the Ablation + CRT arm and in 20 (29%) in the drug arm (HR 0.26, 95% CI 0.10-0.65; P = 0.004). Estimated death rates were 5% vs. 21% at 2 years and 14% vs. 41% at 4 years. The combined endpoint of all-cause mortality or heart failure hospitalization was lower with Ablation + CRT (18 [29%] vs. 36 [51%]; HR 0.40, 95% CI 0.22-0.73; P = 0.002).
- Conclusion
- Ablation + CRT was superior to pharmacological therapy in reducing mortality in patients with permanent AF and narrow QRS hospitalized for heart failure, irrespective of baseline ejection fraction.
- Why it matters
- It suggested that strict, regular rate control through ablation and biventricular pacing can improve survival, not just reduce hospitalizations, in this patient profile, broadening its consideration beyond patients with reduced ejection fraction or wide QRS.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026