Key result
Catheter ablation for atrial fibrillation in patients with heart failure with reduced ejection fraction improves ejection fraction, quality of life, and reduces heart failure hospitalizations and mortality compared to medical therapy.
Why the study?
The management of atrial fibrillation in heart failure has been an ongoing challenge, with no clear evidence for rhythm control until recent trials of catheter ablation such as RAFT-AF.
Does catheter ablation for atrial fibrillation improve outcomes in patients with heart failure with reduced ejection fraction?
Does catheter ablation for atrial fibrillation improve outcomes in patients with heart failure with reduced ejection fraction?
This review highlights that catheter ablation should be strongly considered for patients with HFrEF and atrial fibrillation, as it offers significant improvements in hard clinical outcomes and quality of life compared to medical therapy.
Supports individualized ablation decisions in HFrEF with AF; leaves open need for confirmatory RCTs.
The management of atrial fibrillation in patients with heart failure (HF) has been an on-going challenge, with no clear evidence for a rhythm control strategy until recent clinical trials using catheter ablation. Recently, the RAFT-AF study (randomized ablation-based rhythm-control versus rate-control trial in patients with heart failure and atrial fibrillation; ClinicalTrials.gov identifier: NCT01420393) was published suggesting benefit for atrial fibrillation ablation in patients with HF with reduced ejection fraction. The data from this pivotal trial are reviewed and placed into context with other important trials. Taken together, these studies make a strong argument for considering catheter ablation for patients with HF and reduced but not preserved ejection fraction.
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Skanes et al. (2022) conducted a review in Atrial fibrillation and heart failure with reduced ejection fraction. Catheter ablation vs. Medical therapy (rate or rhythm control) was evaluated. Catheter ablation for atrial fibrillation in patients with heart failure with reduced ejection fraction improves ejection fraction, quality of life, and reduces heart failure hospitalizations and mortality compared to medical therapy.
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