‘Ablate and pace’ reduces mortality in heart failure patients with atrial fibrillation: an updated meta-analysis

Q: What does this research mean for the field?

'Ablate and pace' (predominantly using cardiac resynchronization therapy) reduces all-cause mortality by 36% compared with pharmacological therapy in patients with atrial fibrillation and heart failure, with no significant difference in left ventricular ejection fraction. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Christian Lewinter; John G. F. Cleland; Eslem Sögütlü; Torsten Holm Nielsen; Hannes Hagström; Lars Køber; Martin Lewinter; Robert Edfors; Frieder Braunschweig

doi:10.1093/ehjopen/oeag020

February 16, 2026European Heart Journal OpenOpen Access

‘Ablate and pace’ reduces mortality in heart failure patients with atrial fibrillation: an updated meta-analysis

View Full Paper

Ask AI

Bookmark

Share

Figures

Graphical abstract published by European Heart Journal Open — Graphical abstract · Published by European Heart Journal Open · CC BY

Why the study?

To compare the effects of ablate and pace to pharmacological therapy on mortality and LVEF in AF patients, with or without HF.

Does 'ablate and pace' reduce all-cause mortality and improve left ventricular ejection fraction compared to pharmacological therapy in patients with atrial fibrillation, with or without heart failure?

Structured PICO

Does 'ablate and pace' reduce all-cause mortality and improve left ventricular ejection fraction compared to pharmacological therapy in patients with atrial fibrillation, with or without heart failure?

P

Population

4,292 patients with atrial fibrillation (AF) pooled from 24 studies (4 RCTs, 20 observational). 3,261 patients from 17 studies had symptomatic heart failure with reduced ejection fraction (NYHA Class II-IV, LVEF < 40%). Mean follow-up 3 to 96 months.

I

Intervention

Atrioventricular junction ablation and permanent pacemaker implantation ('ablate and pace'). In heart failure patients, cardiac resynchronization therapy (CRT) was the predominantly chosen pacing mode (84% of studies).

C

Comparator

Pharmacological therapy (medical rate and/or rhythm control for atrial fibrillation).

O

Outcome

All-cause mortality and the mean difference (MD) in left ventricular ejection fraction (LVEF) from baseline to end of follow-up (ranging 3 to 96 months), assessed via echocardiography.hard clinical

An 'ablate and pace' strategy, primarily utilizing cardiac resynchronization therapy, significantly reduces long-term mortality compared to pharmacological therapy in patients with atrial fibrillation and heart failure.

Limitations

Low number of randomized controlled trials (RCTs)
Observational studies add unknown confounder bias and patient selection bias
Use of an LVEF threshold of <40% may have led to misclassification in patients with transiently reduced LVEF
Missing data requiring imputed standard deviations for LVEF mean differences
Semiquantitative echocardiographic measurements of LVEF contributed to substantial heterogeneity

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Ablate and pace' was associated with lower mortality in HF-AF; extends mixed observational/RCT evidence but needs prospective confirmation.

Abstract

Aims We compared the effects of ‘ablate and pace’ to pharmacological therapy on mortality and left ventricular ejection fraction (LVEF) in patients with atrial fibrillation (AF), with or without heart failure (HF). Methods and results Articles were identified by searching PubMed, Central, and Embase until 30 June 2024. Inclusion criteria encompassed observational and randomized controlled trials (RCTs) comparing ‘ablate and pace' with pharmacological therapy and investigating outcomes of mortality and LVEF in patients with AF. An exclusion criterion was lack of a parallel study design. The primary outcomes were all-cause mortality and the mean difference (MD) in LVEF. Endpoints were assessed through meta-analyses computing relative risks (RRs) and MDs. The clinical diagnosis of HF was used to distinguish between patients with and without HF. Initially, 3837 studies were identified, of which 24 (n = 4292 patients) fulfilled the inclusion criteria, including 17 (n = 3261 patients) that focused on HF. Follow-up time varied from 3 to 96 months. Only in HF patients, ‘ablate and pace' reduced mortality significantly with a risk reduction of 36% [RR, 0.64; 95% confidence interval (CI), 0.49–0.85; P < 0.01; n = 10] as compared with pharmacological therapy. Except for two studies, cardiac resynchronization therapy (CRT) was the chosen pace mode. The mortality reduction was independent of study design: RCTs (RR, 0.41; 95% CI, 0.18–0.94; P = 0.04; n = 2) and observational studies (RR, 0.70; 95% CI, 0.55–0.90; P = 0.01; n = 8). ‘Ablate and pace’ and pharmacological therapy were similar for the LVEF outcome (MD, 1.1; 95% CI, −1.6–3.8; P = 0.39; n = 16), which was independent of both HF and study designs (results not shown). Conclusion ‘Ablate and CRT’ reduced mortality in HF patients as compared with pharmacological therapy, which was supported by statistical associations in observational studies. A single RCT corroborated the finding.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Lewinter et al. (2026) studied this question.

synapsesocial.com/papers/6a7cf5423e89d9be1fec233a https://doi.org/10.1093/ehjopen/oeag020

View Full Paper

Ask AI

Bookmark

Share

‘Ablate and pace’ reduces mortality in heart failure patients with atrial fibrillation: an updated meta-analysis

Figures

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

‘Ablate and pace’ reduces mortality in heart failure patients with atrial fibrillation: an updated meta-analysis

Figures

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading