Table 2: Summary of Randomised Controlled Trials of Patients with Heart Failure with Reduced Ejection Fraction (HFrEF) treated with AF Ablation.
| Study | Sample size (ablation group) | Comparison arm | Mean LVEF (%) | Follow-up (months) | Single procedure success (%) | Multiple procedure success (%) | Improvement in LVEF (%) | Other comments |
|---|---|---|---|---|---|---|---|---|
| Khan 2008[48] | 81 (41) | AVJ, CRT | 27 | 6 | 68 | 88 | +8 | Improved 6MWD and Minnesota score |
| MacDonald 2011[54] | 41 (22) | Rate control | 36 | 12 | 40 | 50 | +4 | High rate of complications (%) |
| Jones 2013[49] | 52 (26) | Rate control | 22 | 12 | 68 | 88 | +11 | Improved Minnesota score, BNP, peak oxygen consumption |
| Hunter 2014[50] | 366 (67) | Rate control | 42 | 20 | 38 | 81 | +8 | Improved Minnesota score, peak oxygen consumption Di |
| Biase 2016[51] | 203 (102) | Amiodarone | 29 | 24 | – | 70 | +8 | Improved Minnesota score. Lower mortality and hospitalisation rates |
| Prabhu 2017[52] | 66 (33) | Rate control | 32 | 6 | 56 | – | +18 | Absence of LGE predicted LVEF improvement in ablation group |
| CASTLE-AF 2017[53,55] | 363 (179) | Medical therapy (32% on AAD, mostly amiodarone) | 32 | 60 | – | – | +8 | Lower mortality and heart failure hospitalisation |
AVJ = AV junction ablation; BNP = B-type natriuretic peptide; CRT = cardiac resynchronization therapy; LGE = late gadolinium enhancement; LVEF = left ventricular ejection fraction; 6MWD = 6-minute walk distance. Adapted and modified, with permission, from Verma et al.[25]