Catheter ablation versus medical rate control for persistent atrial fibrillation in older heart failure patients with reduced ejection fraction

BACKGROUND: Patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation are mostly elderly patients, and persistent atrial fibrillation (PerAF) with multiple comorbidities tends to have a worse clinical prognosis. However, there is a lack of randomised trial to investigate the impact of catheter ablation (CA) on outcomes in older PerAF combined with HFrEF. OBJECTIVE: This study aims to compare the effects of CA versus medical rate control (MRC) on severity indicators of HFrEF. METHODS: Older patients with PerAF and HFrEF underwent transthoracic echocardiography and were randomly assigned to receive either AF ablation or MRC. The primary outcome was changes in left ventricular ejection fraction (LVEF). RESULTS: A total of 89 patients (mean age 69.5±3.9 years) were randomly allocated to the CA group (n=45) and MRC group (n=44). Baseline characteristics were similar between the two groups. After 12 months, worsening heart failure requiring unplanned hospitalisation occurred less frequently in the CA group (p=0.019). In CA group, LVEF (from baseline 36.1%±2.7% to 48.9%±7.1%; p<0.00 L) improved higher compared with the MRC group (8.7 (5.9 to 11.5)), p<0.001. Compared with baseline, New York Heart Association functional class and AF burden also showed improvement in CA group than MR group. At a follow-up period of 12 months, sinus rhythm rate was higher in CA group than MRC group, 51.1% versus 20.4%. CONCLUSION: This limited small-scale randomised study showed that CA in older patients with PerAF and HFrEF was associated with a lower likelihood of unplanned hospitalisations due to worsening heart failure with improvement in LVEF and lower AF burden. TRIAL REGISTRATION NUMBER: NCT05827172.