- Question
- Does catheter ablation-based rhythm control improve clinical outcomes compared with rate control in patients with atrial fibrillation (AF) and heart failure (HF)?
- Design
- Multicenter, randomized, open-label trial with blinded outcome evaluation by a central adjudication committee; 411 patients, with a minimum follow-up of 2 years. It was stopped early for apparent futility as determined by the Data Safety Monitoring Committee.
- Population
- Patients with high-burden paroxysmal (more than 4 episodes in 6 months) or persistent (duration under 3 years) AF, NYHA class II-III heart failure, and elevated NT-proBNP.
- Intervention
- Catheter ablation-based rhythm control (pulmonary vein antral and left atrial substrate ablation, with or without adjunctive antiarrhythmic drugs), plus optimal heart failure therapy.
- Control
- Rate control (target resting heart rate below 80 bpm and below 110 bpm during the 6-minute walk), plus optimal heart failure therapy.
- Primary outcome
- Composite of all-cause mortality and all heart failure events.
- Results
- The primary outcome occurred in 50 patients (23.4%) in the ablation group and 64 (32.5%) in the rate-control group (HR 0.71; 95% CI 0.49-1.03; P=0.066), which was not statistically significant. Left ventricular ejection fraction and 6-minute walk distance improved more with ablation.
- Safety
- Serious adverse events occurred in 50% of patients in both treatment groups.
- Conclusion
- In patients with high-burden AF and HF, there was no significant difference in mortality or HF events between ablation and rate control, although there was a nonsignificant trend favoring ablation.
- Why it matters
- It added randomized evidence on the role of ablation in AF with heart failure, showing a favorable trend and improved functional and quality-of-life measures, but without confirming a clear benefit on hard outcomes.
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