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. Author manuscript; available in PMC: 2024 May 15.
Published in final edited form as: Circulation. 2023 Nov 30;149(1):e1–e156. doi: 10.1161/CIR.0000000000001193

Table 27.

Randomized Trials of Rhythm Control in HF

Study/Author (y) No. Pts. Inclusion Exclusion Intervention Primary Outcome Death and Hospitalization Death Hospital izations Reduction in AF LVEF QOL 6MWT Peak VO2 Max BNP
Roy (2008)60 1376 LVEF <35%, CHF AAD (primarily amiodarone) vs rate control Cardiovascular mortality was no different between rhythm vs rate control No change No difference No difference
MacDonald (2011)8 41 Persistent AF; LVEF <35%, CHF II-IV PAF; QRS >150 RF to medical therapy Similar increase in CMR LVEF No difference Improved with RF Improved No change No change
ARC-HF: Jones (2013)6 52 Persistent AF; LVEF <35%, CHF RF to medical therapy Improvement in peak VO2 with RF No change No difference No difference No change Improved with RF No change Improved
CAMTAF (2014)5 50 Persistent AF; LVEF <50%; CHF RF to medical therapy LVEF significantly improved with RF No change No difference Improved Improved with RF Improved
AATAC (2016)4 203 Persistent AF; LVEF <40%, CHF II-III RF to amiodarone At 24 mo, RF patients more likely to be in NSR Improvement with RF Improved Improved Improved Improved with ablation Improved
CAMERA MRI (2017)12 66 Persistent AF; LVEF <45%, CHF II-III; idiopathic CM RF to medical therapy Improved LVEF with RF Improved No change No change Improved
CASTLE-AF (2018)9 363 PAF or persistent AF; LVEF <36%, CHF II-IV and ICD RF to medical therapy Composite of death and hospitalization lower with RF Improvement with RF Improved Improved Improved
AMICA (2019)7 140 Persistent AF; LVEF <36% RF to medical therapy No difference in change in LVEF No change No change No change No change
CABANA substudy (2021)14 778 Clinical HF (largely HFpEF) RF to medical therapy Decrease in composite of MACE Improved Improved with RF Improved with RF
RAFT-AF (2022)11 411 ≥4 PAF/y or persistent AF, NYHA class II or III HF, elevated pro-BNP RF to medical therapy No difference in change in mortality/HF No difference in change in mortality/HF No change No change Improved with RF Improved with RF Improved with RF Improved with RF Improved with RF
Meta-analysis-Turagam (2019)13 775 RF to medical therapy Improved Reduced Improved Improved Improved Improved
Meta-analysis-Chen (2020)3 1112 RF to medical therapy Improved Reduced Improved with RF Improved Improved
Meta-analysis-Pan (2021)10 775 RF to medical therapy Improved Reduced Improved Improved Improved

AAD indicates antiarrhythmic drug; AATAC, Ablation vs Amiodarone for Treatment of Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted ICD/CRTD; AF, atrial fibrillation; AMICA, Atrial Fibrillation Management in Congestive Heart Failure With Ablation; ARC-HF, A Randomised Trial to Assess Catheter Ablation Versus Rate Control in the Management of Persistent Atrial Fibrillation in Chronic Heart Failure; BNP, brain natriuretic peptide; CABANA, Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation; CAMERA MRI, Catheter Ablation versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction-an MRI-Guided Multi-centre Randomised Controlled Trial; CAMTAF, Catheter Ablation Versus Medical Treatment of AF in Heart Failure; CASTLE-AF, Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation; CHF, congestive heart failure; CM, cardiomyopathy; CMR, cardiac magnetic resonance: HF, heart failure; HFpEF, heart failure with persistent ejection fraction; ICD, implantable cardioverter-defibrillator; LVEF, left ventricular ejection fraction; MACE, major adverse cardiovascular events; NSR, normal sinus rhythm; NYHA, New York Heart Association; PAF, paroxysmal atrial fibrillation; QOL, quality of life; RAFT-AF, Rhythm Control–Catheter Ablation With or Without Anti-arrhythmic Drug Control of Maintaining Sinus Rhythm Versus Rate Control With Medical Therapy and/or Atrio-ventricular Junction Ablation and Pacemaker Treatment for Atrial Fibrillation; RF, radiofrequency; VO2 max, maximal oxygen consumption; and 6MWT, 6-minute walk test.