Table 1.
Main trials comparing CA for AF in HF. Bold character is for study primary outcome. Asterisks (*) denote statistical significance. AAD: anti-arrhythmic drugs; AFEQT: atrial fibrillation effect on quality of life; AVN: atrio-ventricular node; CRT: cardiac resynchronization therapy; EF: ejection fraction; ICD: implantable cardioverter-defibrillator; MLHFQ: Minnesota living with heart failure questionnaire; NYHA: New York Heart Association; PAF: paroxysmal atrial fibrillation; PerAF: persistent atrial fibrillation.
| PABA-CHF [67] (2008) |
ARC-HF [68] (2013) |
CAMTAF [69] (2014) |
CAMERA-MRI [30] (2017) |
AATAC [32] (2016) |
CASTLE-AF [33] (2018) |
CABANA Subgroup [44] (2021) |
RAFT-AF [36] (2022) |
|
|---|---|---|---|---|---|---|---|---|
| Sample size | 81 | 52 | 50 | 68 | 203 | 363 | 778 | 411 |
| Population | EF < 40% NYHA II-III PAF/PerAF |
EF < 35% NYHA II-IV PerAF |
EF < 50% NYHA II-IV PerAF |
EF < 45% (MR) NYHA II–IV PerAF No CAD |
EF < 40% NYHA II-III PerAF ICD/CRT-D |
EF < 35% NYHA II-IV PAF/PerAF ICD/CRT-D |
NYHA II-IV PAF/PerAF >65 years or <65 years + 1 risk factor for stroke |
NYHA II/III PAF/PerAF High NT-proBNP |
| Control group | AVN ablation + CRT | Rate control | Rate control | Rate control | Amiodarone | Pharmacologic rate or rhythm control | Pharmacologic rate or rhythm control | Pharmacologic rate control |
| Follow-up (months) | 6 | 12 | 12 | 6 | 24 | 60 | 60 | 24 |
| AF-free survival | 71% AAD off | 68% AAD off | 38% AAD off | 56% AAD off | 70% AAD off vs. 34% with AAD * | 63.1% AAD off vs. 21.7% with AAD * |
73% AAD off vs. 42% with AAD * |
85.6% AAD off vs. 12.9% with AAD * |
| LVEF | 35% vs. 28% * | +5.6% * | 40% vs. 31% * | Δ 18% vs. 4.4% * | Δ 8.1% vs. 6.2% * | Δ 8.0% vs. 0.2% * | 10.1% vs. 3.8% * | |
| Peak O2 | Δ +3.07 mL/kg/min * | 22 vs. 18 mL/kg/′ * | ||||||
| BNP | Δ −124 vs. −18 pg/mL * | 126 vs. 327 pg/mL * | 98 vs. 247 pg/mL * | −77.1% vs. −39.2% * | ||||
| 6′ walk (m) | 340 vs. 297 * | +21 vs. −10 (n.s.) | Δ 22 vs. 10 * | Δ 0 vs. −30 | Δ 44.9 vs. 27.5 * | |||
| QoL |
MLHFQ
60 vs. 81 * |
MLHFQ median −15.5 vs. −5 * |
MLHFQ 24 ± 22 vs. 47 ± 22 * |
SF 36 physical score 48.5 vs. 44.6 * |
MLHFQ Δ 11 vs. 6 * |
AFEQT 2.5 vs. 7.4 * |
MLHFQ −5.4 * |
|
| Clinical outcome | Death: 8% vs. 18% * |
Death/hospitalization:
28.5% vs. 44.6% * |
Death/stroke/bleeding:
9.0% vs. 12.3% * |
Death/HF event:
23.4% vs. 32.5% |