- Question
- Does catheter ablation of atrial fibrillation, added to guideline-directed medical therapy, improve clinical outcomes in patients with end-stage heart failure referred for transplant evaluation?
- Design
- Single-center, open-label, randomized trial conducted in Germany with 194 patients (97 per group). Median follow-up was 18.0 months. The data and safety monitoring board stopped the trial for efficacy 1 year after randomization was completed.
- Population
- Patients with symptomatic atrial fibrillation and end-stage heart failure who were referred for heart transplantation evaluation.
- Intervention
- Catheter ablation plus guideline-directed medical therapy. Ablation was performed in 81 of 97 patients (84%) in the ablation group.
- Control
- Guideline-directed medical therapy alone. In this group, 16 of 97 patients (16%) nonetheless underwent ablation.
- Primary outcome
- Composite of death from any cause, implantation of a left ventricular assist device, or urgent heart transplantation.
- Results
- A primary end-point event occurred in 8 patients (8%) in the ablation group and 29 (30%) in the medical-therapy group (HR 0.24; 95% CI 0.11 to 0.52; P<0.001). Death from any cause occurred in 6 patients (6%) vs. 19 (20%) (HR 0.29; 95% CI 0.12 to 0.72).
- Safety
- Procedure-related complications occurred in 3 patients in the ablation group and in 1 patient in the medical-therapy group.
- Conclusion
- In patients with atrial fibrillation and end-stage heart failure, ablation plus medical therapy was associated with a lower likelihood of death, left ventricular assist device implantation, or urgent transplantation than medical therapy alone.
- Why it matters
- It provided randomized evidence in a very high-risk group previously underrepresented in trials, supporting consideration of atrial fibrillation ablation as a strategy in advanced heart failure, with the caveat that it was a single-center, open-label trial.
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