- Question
- Does catheter ablation of atrial fibrillation improve clinical outcomes in patients with heart failure compared with medical therapy?
- Design
- Randomized, open-label (unmasked) phase 4 trial comparing catheter ablation (179 patients) with medical therapy (184 patients), with a median follow-up of 37.8 months. Funded by Biotronik.
- Population
- Patients with symptomatic paroxysmal or persistent atrial fibrillation who did not respond to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take them. All had NYHA class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator.
- Intervention
- Radiofrequency catheter ablation of atrial fibrillation, aiming to isolate the pulmonary veins and restore sinus rhythm, in addition to guideline-based heart failure therapy.
- Control
- Conventional medical therapy for atrial fibrillation (rate or rhythm control), in addition to guideline-based heart failure therapy.
- Primary outcome
- Composite of death from any cause or hospitalization for worsening heart failure.
- Results
- The primary endpoint occurred in 51 patients (28.5%) in the ablation group versus 82 (44.6%) in the medical-therapy group (HR 0.62; 95% CI 0.43 to 0.87; P=0.007). All-cause death was lower with ablation: 24 (13.4%) versus 46 (25.0%) (HR 0.53; 95% CI 0.32 to 0.86; P=0.01).
- Conclusion
- In patients with heart failure, catheter ablation for atrial fibrillation was associated with a significantly lower rate of the composite of death from any cause or hospitalization for worsening heart failure than medical therapy.
- Why it matters
- It provided evidence that, in selected patients with heart failure with reduced ejection fraction and atrial fibrillation, an ablation strategy can improve hard outcomes and not only symptoms, prompting its consideration as a treatment option in this group.
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 7, 2026