Table 1.

Atrial fibrillation ablation in HFrEF.

	CASTLE-AF	RAFT-AF	CASTLE-HTX	AMICA TRIAL	CAMERA- MRI
Year	2018	2022	2023	2019	2017
Design	Multicenter open label RCT	Multicenter open-label RCT	Single-center open-label RCT	Multicenter open-label RCT	Multicenter RCT
Mean age (years)	64 ± 5	67 ± 8	64 ± 11	65 ± 8	61 ± 10
AF type	Parox: 32.5% Pers: 38.3% LS-pers: 29.2%	Parox: 7.3% Pers: 69.3% LS-pers: 23.4%	Parox: 30% Pers: 56% LS-pers: 14%	Pers: 76.4% LS-pers: 23.6%	Pers: 100%
Baseline LVEF	25–38%	41 ± 15%	27 ± 6%	26 ± 9%	33 ± 9%
NYHA	I: 11% II: 60% III: 28% IV: 1%	II: 67% III: 33%	II: 31% III: 55% IV: 14%	II: 39% III: 61%	Mean NYHA class: 2.5 ± 0.6
Adjunctive ablation targets other than PVI	ND	91.2%	ND	33%	100%
Control arm therapy	Medical therapy	Rate control	Guideline directed	Best medical therapy	Rate control
Primary outcome	All-cause mortality and HF hospitalization	All-cause mortality and HF events	Death from any cause, LVAD implantation or urgent heart TX	Absolute increase in LVEF	Change in LVEF at 6 months
Mean change in LVEF (ablation vs. control)	8.0% vs. 0.2%	10.1 ± 1.2 vs. 3.8 ± 1.2	7.8 ± 7.6 vs. 1.4 ± 7.2	8.8% vs. 7.3%	18.3% vs. 4.4%
Rhythm control outcome (ablation vs. control)	63.1 vs. 21.7% in SR (5 years)	85.6 vs. 12.9% in SR at 2 years	31.4 ± 33.3 vs. 8.6 ± 26.3 AF burden reduction at 1 year	73.5% vs. 50% in SR	25% vs. 100% in AF
Main findings	Reduction in all-cause death or HF hospitalization	Similar primary outcomes and increase in LVEF	Reduction in primary composite endpoint	No LVEF improvement	LVEF improvement
Follow-up (months)	38	37	18	12	6

RCT: randomized controlled trial; AF: atrial fibrillation; Parox: paroxysmal AF; Pers: persistent AF; LS-Pers: long-standing AF; LVEF: left ventricular ejection fraction; SR: sinus rhythm; HF: heart failure; LVAD: left ventricular assist device; heart TX: heart transplantation; PVI: pulmonary vein isolation; NYHA: New York Heart Association score.