Table 2.
Overview of recent (ablation) studies for the treatment of atrial fibrillation (AF) in the setting of heart failure (HF)
| Study | No of patients | Mean age | Women | Inclusion criteria | Endpoint | Comparison | PVI | Comorbidity treatment | Follow-up (years) | Outcome |
| Recent AF ablation trials | ||||||||||
| PABA-CHF 13 | 81 | 60 | 8% | NYHA III/IV and LVEF <40% | Composite of QOL, LVEF, 6-MWT | PVI versus AVN ablation | 51% | Not specified | 0.5 | PVI was superior (p<0.001) |
| MacDonald et al 15 | 41 | 63 | 22% | NYHA II (11%)/III (89%) and LVEF <35% | Change in LVEF | PVI versus rate control (digoxin) | 54% | Not specified | 0.5 or 0.75 | PVI did not improve LVEF (p=ns) |
| ARC-HF17 | 52 | 63 | 13% | NYHA II–IV and LVEF <35% | 12-month change in peak oxygen consumption | PVI versus rate control | 50% | Not specified | 1.0 | PVI was superior (p=0.018) |
| CAMTAF18 | 50 | 57 | 4% | NYHA II (46%)/ III (54%) and LVEF <50% | Difference in LVEF | PVI versus rate control | 52% | Not specified | 1.0 | PVI was superior (p=0.015) |
| AATAC16 | 203 | 61 | 26% | NYHA II–IV and LVEF <40% | Recurrence of AF | PVI versus amiodarone | 50% | Not specified | 2.0 | PVI was superior (p<0.0001) |
| CAMERA-MRI19 | 68 | 61 | 9% | LVEF <45% | Change in LVEF | PVI versus rate control | 50% | Not specified | 0.5 | PVI was superior (p<0.0001) |
| CASTLE-AF14 | 363 | 64 | 14% | NYHA I–IV (11%, 58%, 27%, 1%) and LVEF <35% | Composite of ACM of HF hospitalisation | PVI versus medical therapy (rhythm or rate control) | 49% | Not specified | 3.1 | PVI was superior (p=0.007) |
| CABANA-HF (post-hoc)38 | 778 | 68 | 44% | NYHA II–IV (76%, 23%, 1%) | Composite of ACM, stroke, bleeding, CA | PVI versus medical therapy (rhythm or rate control) | 49% | Not specified | 4.0 | PVI was superior (p=significant) |
| Recent AF trials (overall results) | ||||||||||
| RACE 37 | 245 | 64 | 21% | HFrEF=NYHA I–III and LVEF <45%. HFpEF=NYHA II–III and LVEF >45% |
Sinus rhythm on 7-day Holter | Targeted therapy of underlying conditions versus conventional (causal treatment of AF and HF+rhythm control) | N/A | Targeted therapy | 1.0 | Targeted therapy was superior (p=0.042) at 1 year; no differences at 5 years |
| EAST-AFNET 440 | 2789 | 70 | 46% | Stable heart failure (n=798 (28.6%))* | Composite of death from CV causes, stroke, hospitalisation for HF or ACS | Early rhythm control or usual care (initial rate control, in case of symptoms mitigation to rhythm control) | 13% | According to guidelines | 5.1 | Early rhythm control was superior (p=0.005) |
*No subgroup data available yet.
ACM, all-cause mortality; ACS, acute coronary syndrome; AVN, AV nodal ablation; CA, cardiac arrest; CV, cardiovascular; HFpEF, HF with preserved ejection fraction; HFrEF, HF with reduced ejection fraction; LVEF, left ventricular ejection fraction; 6-MWT, 6-minute walk test; N/A, not available; NYHA, New York Heart Association; PVI, pulmonary vein isolation; QOL, quality of life.