A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure
Open accessAbstract
Objectives This study sought to compare catheter ablation with rate control for persistent atrial fibrillation (AF) in heart failure (HF).Background The optimal therapy for AF in HF is unclear. Drug-based rhythm control has not proved clinically beneficial. Catheter ablation improves cardiac function in patients with HF, but impact on physiological performance has not been formally evaluated in a randomized trial.Methods In a randomized, open-label, blinded-endpoint clinical trial, adults with symptomatic HF, radionuclide left ventricular ejection fraction (EF) ≤35%, and persistent AF were assigned to undergo catheter ablation or rate control. Primary outcome was 12-month change in peak oxygen consumption. Secondary endpoints were quality of life, B-type natriuretic peptide, 6-min walk distance, and EF. Results were analyzed by intention-to-treat.Results Fifty-two patients (age 63 ± 9 years, EF 24 ± 8%) were randomized, 26 each to ablation and rate control. At 12 months, 88% of ablation patients maintained sinus rhythm (single-procedure success 68%). Under rate control, rate criteria were achieved in 96%. The primary endpoint, peak oxygen consumption, significantly increased in the ablation arm compared with rate control (difference +3.07 ml/kg/min, 95% confidence interval: 0.56 to 5.59, p = 0.018). The change was not evident at 3 months (+0.79 ml/kg/min, 95% confidence interval: -1.01 to 2.60, p = 0.38). Ablation improved Minnesota score (p = 0.019) and B-type natriuretic peptide (p = 0.045) and showed nonsignificant trends toward improved 6-min walk distance (p = 0.095) and EF (p = 0.055).Conclusions This first randomized trial of ablation versus rate control to focus on objective exercise performance in AF and HF shows significant benefit from ablation, a strategy that also improves symptoms and neurohormonal status. The effects develop over 12 months, consistent with progressive amelioration of the HF syndrome. (A Randomised Trial to Assess Catheter Ablation Versus Rate Control in the Management of Persistent Atrial Fibrillation in Chronic Heart Failure; NCT00878384).
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For patients who develop HFrEF as a result of rapid AF (tachycardiomyopathy), a rhythm control strategy is preferred, based on several relatively small patient cohorts and trials reporting improved LV function after restoration of sinus rhythm.
“For patients who develop HFrEF as a result of rapid AF (tachycardiomyopathy), a rhythm control strategy is preferred, based on several relatively small patient cohorts and trials reporting improved LV function after restoration of sinus rhythm.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [185]
Catheter ablation may be a useful method to restore LV function and quality of life in AF patients with HFrEF, but further data are needed.
“Catheter ablation may be a useful method to restore LV function and quality of life in AF patients with HFrEF, 185,[226][227][228] but further data are needed.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [185]
In patients with symptomatic paroxysmal, persistent, and probably long-standing persistent atrial fibrillation, catheter ablation is more effective than antiarrhythmic drug therapy.
“In such patients, catheter ablation is more effective than antiarrhythmic drug therapy.185,586,713,[717][718][719][720]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [185]
Catheter ablation of atrial fibrillation is effective in restoring and maintaining sinus rhythm in patients with symptomatic paroxysmal, persistent, and probably long-standing persistent atrial fibrillation, generally as second-line treatment after failure of or intolerance to antiarrhythmic drug therapy.
“Catheter ablation of AF is effective in restoring and maintaining sinus rhythm in patients with symptomatic paroxysmal, persistent, and probably long-standing persistent AF -in general as second-line treatment after failure of or intolerance to antiarrhythmic drug therapy.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [185]
Fewer data are available reporting the effectiveness and safety of catheter ablation in patients with persistent or long-standing persistent atrial fibrillation.
“Fewer data are available reporting the effectiveness and safety of catheter ablation in patients with persistent or long-standing persistent AF, but all point to lower recurrence rates after catheter ablation compared to antiarrhythmic drug therapy with or without cardioversion.185,717,[723][724][725][726]1039”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [185]
All available data point to lower recurrence rates after catheter ablation compared to antiarrhythmic drug therapy with or without cardioversion in patients with persistent or long-standing persistent atrial fibrillation.
“Fewer data are available reporting the effectiveness and safety of catheter ablation in patients with persistent or long-standing persistent AF, but all point to lower recurrence rates after catheter ablation compared to antiarrhythmic drug therapy with or without cardioversion.185,717,[723][724][725][726]1039”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [185]
Several smaller trials suggest improved left ventricular function after catheter ablation in heart failure with reduced ejection fraction patients.
“Several smaller trials suggest improved LV function after catheter ablation in HFrEF patients 185, 226-228, 778, 779”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [185]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.
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“ferred, based on several relatively small patient cohorts and trials reporting improved LV function after restoration of sinus rhythm.(185,226) – 228 The diagnosis of tachycardiomyopathy can be challenging, and at times requires the restoration of sinus rhythm.”
2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
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“Two small studies of AF ablation compared with rate control met with mixed success in terms of procedural complications and success in improving symptoms.(278,279) The most recent evidence from a meta-analysis that included 914 patients suggests an encouraging success rate of PV ablation of AF in patients with LV dysf…”
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“capacity and QoL with AF ablation in comparison with pharmacological rate control.(14,36) The CAMTAF trial also showed a significant improve-”
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“Numerous studies have evaluated the efficacy of catheter ablation of both paroxysmal and persistent atrial fibrillation with significant impairment of systolic function [437,466–473].”
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Tzeis, S. E., Gerstenfeld, E. P., Kalman, J. M., Saad, E., Shamloo, A. S., Andrade, J. G., Barbhaiya, C. R., Baykaner, T., Bovéda, S., Calkins, H. G., et al. (2024) · EP Europace · doi:10.1093/europace/euae043 · Cited by 692 · see citing works
Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction
Prabhu, S., Taylor, A. J., Costello, B. T., Kaye, D. M., McLellan, A. J. A., Voskoboinik, A., Sugumar, H., Lockwood, S. M., Stokes, M. B., Pathik, B., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.08.041 · Cited by 661 · see citing works
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“Since commencement of the Catheter Ablation Versus Medical Treatment of Atrial Fibrillation (CAMTAF) trial, there have been 3 trials published comparing catheter ablation with rate control in patients with AF and HF: PABA CHF (Pulmonary Vein Antrum Isolation versus AV Node Ablation with Bi-Ventricular Pacing for Treat…”
MethodResultAblation Versus Drug Therapy for Atrial Fibrillation in Heart Failure
Packer, D. L., Piccini, J. P., Monahan, K. H., Al‐Khalidi, H. R., Silverstein, A. P., Noseworthy, P. A., Poole, J. E., Bahnson, T. D., Lee, K. L., Mark, D. B., et al. (2021) · Circulation · doi:10.1161/circulationaha.120.050991 · Cited by 493 · see citing works
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Ponikowski, P. P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., Falk, V., González‐Juanatey, J. R., Harjola, V., Jankowska, E. A., et al. (2016) · Kardiologia Polska · doi:10.5603/kp.2016.0141 · Cited by 450 · see citing works
Atherton, J. J., Sindone, A. P., Pasquale, C. G. D., Driscoll, A. L., Macdonald, P. S., Hopper, I., Kistler, P. M., Briffa, T. G., Wong, J., Abhayaratna, W. P., et al. (2018) · Heart Lung and Circulation · doi:10.1016/j.hlc.2018.06.1042 · Cited by 431 · see citing works
“Several randomised studies comparing catheter ablation for AF and medical rate control have demonstrated significant improvements in LVEF, NYHA functional class symptoms and reductions in BNP with catheter ablation [403,404].”
Background2020 Clinical practice guidelines for Chronic heart failure
Russian Society of Cardiology (2020) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2020-4083 · Cited by 529 · see citing works
Heart Failure and Atrial Fibrillation, Like Fire and Fury
Carlisle, M. A., Fudim, M., DeVore, A. D., & Piccini, J. P. (2019) · JACC Heart Failure · doi:10.1016/j.jchf.2019.03.005 · Cited by 391 · see citing works
Atrial fibrillation in heart failure: what should we do?
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Avoiding non-responders to cardiac resynchronization therapy: a practical guide
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Catheter ablation for atrial fibrillation: current indications and evolving technologies
Parameswaran, R., Al‐Kaisey, A., & Kalman, J. M. (2020) · Nature Reviews Cardiology · doi:10.1038/s41569-020-00451-x · Cited by 251 · see citing works
Andrade, J. G., Verma, A., Mitchell, L. B., Parkash, R., Leblanc, K., Atzema, C. L., Healey, J. S., Bell, A., Cairns, J. A., Connolly, S. J., et al. (2018) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2018.08.026 · Cited by 235 · see citing works
2020 Clinical guidelines for Atrial fibrillation and atrial flutter
Arakelyan, M., Bockeria, L., Vasilieva, E., Golitsyn, S., Golukhova, E., Gorev, M., Davtyan, K., Drapkina, O., Kropacheva, E., Kuchinskaya, E. A., et al. (2021) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2021-4594 · Cited by 11 · see citing works
Catheter Ablation Versus Medical Therapy for Atrial Fibrillation
Asad, Z. U. A., Yousif, A., Khan, M. S., Al‐Khatib, S. M., & Stavrakis, S. (2019) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.119.007414 · Cited by 226 · see citing works
“…al 2009 RFA 35 63 57 100 63 46 55 46/54 44 20 Warfarin d/c 6 mo post-ablation MT 35 65 65 100 69 54 53 37/63 45 20 Warfarin throughout study period Jones et al 2013 RFA 26 64 81 50 38 MT 26 62 92 22 45 29 0/100 46 37 Krittayaphong et al 2003 RFA 15 55 73 7 13 64 73/27 39 Warfarin MT 15 49 53 20…”
Calkins, H. G., Hindricks, G., Cappato, R., Kim, Y., Saad, E., Aguinaga, L., Akar, J. G., Badhwar, V., Brugada, J., Camm, A. J., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.07.009 · Cited by 225 · see citing works
Comorbidity of atrial fibrillation and heart failure
Ling, L., Kistler, P. M., Kalman, J. M., SCHILLING, R. J., & Hunter, R. J. (2015) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2015.191 · Cited by 213 · see citing works
2024 Clinical practice guidelines for Chronic heart failure
Galyavich, A. S., Tereshchenko, S. N., Uskach, T. M., Ageev, F. T., Aronov, D. M., Arutyunov, G. P., Begrambekova, Y. L., Belenkov, Y. N., Boytsov, S. A., Bubnova, M. G., et al. (2024) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2024-6162 · Cited by 251 · see citing works
JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias
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Rate- and Rhythm-Control Therapies in Patients With Atrial Fibrillation: A Systematic Review
Al-Khatib, S. M., Allen LaPointe, N. M., Chatterjee, R., Crowley, M. J., Dupre, M. E., Kong, D. F., Lopes, R. D., Povsic, T. J., Raju, S. S., Shah, B., et al. (2014) · Annals of Internal Medicine · doi:10.7326/m13-1467 · Cited by 178 · see citing works
“Three studies compared a rhythm-control strategy involving catheter ablation with a rate-control strategy involving rate-controlling medications (32) or AVN ablation combined with implantation of a pacemaker (30) or ratecontrolling medications (31).”
BackgroundMethodGopinathannair, R., Chen, L. Y., Chung, M. K., Cornwell, W. K., Furie, K. L., Lakkireddy, D. R., Marrouche, N. F., Natale, A., Olshansky, B., & Joglar, J. A. (2021) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/hae.0000000000000078 · Cited by 187 · see citing works
Anselmino, M., Matta, M., D’Ascenzo, F., Bunch, T. J., Schilling, R. J., Hunter, R. J., Pappone, C., Neumann, T., Noelker, G., Fiala, M., et al. (2014) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.114.001938 · Cited by 174 · see citing works
“However, recent randomized data suggest a similar improvement in LV function with definitive restoration of SR by AFCA, with little if any effect by increasing rate control.(13,21) Because AFCA is recommended only in case of rate and pharmacological rhythm control strategies failure, the incidence of real isolated tac…”
BackgroundJCS/JHRS 2019 guideline on non‐pharmacotherapy of cardiac arrhythmias
Nogami, A., Kurita, T., Abe, H., Andò, K., Ishikawa, T., Imai, K., Usui, A., Okishige, K., Kusano, K., Kumagai, K., et al. (2021) · Journal of Arrhythmia · doi:10.1002/joa3.12491 · Cited by 164 · see citing works
Chen, S., Pürerfellner, H., Meyer, C. G., Acou, W., Schratter, A., Ling, Z., Liu, S., Yin, Y., Martinek, M., Kiuchi, M. G., et al. (2019) · European Heart Journal · doi:10.1093/eurheartj/ehz443 · Cited by 159 · see citing works
Impact of Atrial Fibrillation on Exercise Capacity in Heart Failure With Preserved Ejection Fraction
Zakeri, R., Borlaug, B. A., McNulty, S. E., Mohammed, S. F., Lewis, G. D., Semigran, M. J., Deswal, A. M., LeWinter, M. M., Hernandez, A. F., D, E. B. M., et al. (2013) · Circulation Heart Failure · doi:10.1161/circheartfailure.113.000568 · Cited by 158 · see citing works
Catheter ablation in patients with persistent atrial fibrillation
Kirchhof, P. F., & Calkins, H. G. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw260 · Cited by 156 · see citing works
Reddy, Y. N. V., Borlaug, B. A., & Gersh, B. J. (2022) · Circulation · doi:10.1161/circulationaha.122.057444 · Cited by 157 · see citing works
Wynn, G. J., Das, M., Bonnett, L. J., Panikker, S., Wong, T., & Gupta, D. (2014) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.114.001759 · Cited by 146 · see citing works
Goette, A., Kalman, J. M., Aguinaga, L., Akar, J. G., Cabrera, J. Á., Chen, S. A., Chugh, S. S., Corradi, D., d’Ávila, A., Dobrev, D., et al. (2016) · Journal of Arrhythmia · doi:10.1016/j.joa.2016.05.002 · Cited by 148 · see citing works
Catheter Ablation of Atrial Fibrillation Using Zero‐Fluoroscopy Technique: A Randomized Trial
Bulava, A., Haniš, J., & Eisenberger, M. (2015) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.12634 · Cited by 143 · see citing works
Tachycardia mediated cardiomyopathy: Pathophysiology, mechanisms, clinical features and management
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Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure
Turagam, M. K., Garg, J., Whang, W., Sartori, S., Koruth, J. S., Miller, M. A., Langan, N., Sofi, A. A., Gomes, A., Choudry, S., et al. (2018) · Annals of Internal Medicine · doi:10.7326/m18-0992 · Cited by 132 · see citing works
JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias
Ono, K., Iwasaki, Y., Akao, M., Ikeda, T., Ishii, K., Inden, Y., Kusano, K., Kobayashi, Y., Koretsune, Y., Sasano, T., et al. (2022) · Circulation Journal · doi:10.1253/circj.cj-20-1212 · Cited by 132 · see citing works
Treatment of Patients With Atrial Fibrillation and Heart Failure With Reduced Ejection Fraction
Verma, A., Kalman, J. M., & Callans, D. J. (2017) · Circulation · doi:10.1161/circulationaha.116.026054 · Cited by 124 · see citing works
Arnar, D. O., Mairesse, G. H., Boriani, G., Calkins, H. G., Chin, A., Coats, A. J. S., Deharo, J., Svendsen, J. H., Heidbüchel, H., Isa, R., et al. (2019) · EP Europace · doi:10.1093/europace/euz046 · Cited by 120 · see citing works
Atrial Fibrillation and Heart Failure — Cause or Effect?
Prabhu, S., Voskoboinik, A., Kaye, D. M., & Kistler, P. M. (2017) · Heart Lung and Circulation · doi:10.1016/j.hlc.2017.05.117 · Cited by 111 · see citing works
Panikker, S., Jarman, J. W. E., Virmani, R., Kutys, R., Haldar, S., Lim, E., Butcher, C., Khan, H. R., Mantziari, L., Nicol, E. D., et al. (2016) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.115.003710 · Cited by 110 · see citing works
Catheter Ablation for Atrial Fibrillation in Heart Failure Patients
Al Halabi, S., Qintar, M., Hussein, A., Alraies, M. C., Jones, D. G., Wong, T., MacDonald, M. R., Petrie, M. C., Cantillon, D., Tarakji, K. G., et al. (2015) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2015.02.018 · Cited by 105 · see citing works
“We were able to obtain previously unpublished data on complications and incorporate them into our analysis from 2 RCTs (23,24).”
MethodImpact of SGLT2 Inhibitors on AF Recurrence After Catheter Ablation in Patients With Type 2 Diabetes
Abu-Qaoud, M. R., Kumar, A., Tarun, T., Abraham, S., Ahmad, J., Khadke, S., Husami, R., Kulbak, G., Sahoo, S., Januzzi, J. L., et al. (2023) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2023.06.008 · Cited by 104 · see citing works
Atrial fibrillation: comorbidities, lifestyle, and patient factors
Shantsila, E., Choi, E., Lane, D. A., Joung, B., & Lip, G. Y. H. (2024) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2023.100784 · Cited by 104 · see citing works
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Lip, G. Y. H., Heinzel, F. R., Gaïta, F., González‐Juanatey, J. R., Heuzey, J. Y. L., Potpara, T., Svendsen, J. H., Vos, M. A., Anker, S. D., Coats, A. J. S., et al. (2015) · EP Europace · doi:10.1093/europace/euv191 · Cited by 95 · see citing works
“177,180,183 These trial data have confirmed the observational series in terms of freedom from AF, improvement in LVEF, and QoL.”
InfluentialMohanty, S., Santangeli, P., Mohanty, P. K., Biase, L. D., Holcomb, S., Trivedi, C. G., Bai, R., BURKHARDT, D. J., Hongo, R. H., Hao, S. C., et al. (2014) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12467 · Cited by 92 · see citing works
Rhythm Control in Heart Failure Patients With Atrial Fibrillation
Trulock, K. M., Narayan, S. M., & Piccini, J. P. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.06.1169 · Cited by 91 · see citing works
“Specifically, the ARCHF (A Randomised Trial to Assess Catheter Ablation Versus Rate Control in the Management of Persistent Atrial Fibrillation in Chronic Heart Failure) investigators (71) reported a trend toward EF improvement in the ablation group at 12 months, whereas the CAMTAF (Catheter Ablation Versus Medical Tr…”
BackgroundMethodSteinberg, B. A., Li, Z., O'Brien, E. C., Pritchard, J. E., Chew, D. S., Bunch, T. J., Mark, D. B., Nabutovsky, Y., Greiner, M. A., & Piccini, J. P. (2021) · Heart Rhythm · doi:10.1016/j.hrthm.2021.01.021 · Cited by 89 · see citing works
2020 Clinical practice guidelines for Chronic heart failure
Russian Society of Cardiology (2020) · Russian Journal of Cardiology · doi:10.15829/29/1560-4071-2020-4083 · Cited by 88 · see citing works
Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation
Willems, S., Meyer, C. G., de Bono, J. P., Brandes, A., Eckardt, L., Elvan, A., Gelder, I. C. V., Goette, A., Gulizia, M. M., Haegeli, L., et al. (2019) · European Heart Journal · doi:10.1093/eurheartj/ehz782 · Cited by 80 · see citing works
Şaylık, F., Çınar, T., Akbulut, T., & Hayıroğlu, M. İ. (2022) · Heart & Lung · doi:10.1016/j.hrtlng.2022.08.012 · Cited by 79 · see citing works
Anić, A., Phlips, T., Brešković, T., Koopman, P., Girouard, S. D., Mediratta, V., Jurišić, Z., Sikiric, I., Lisica, L., & Vijgen, J. M. (2023) · EP Europace · doi:10.1093/europace/euad147 · Cited by 80 · see citing works
Atrial Fibrillation Ablation in Heart Failure With Reduced vs Preserved Ejection Fraction
Oraii, A., McIntyre, W. F., Parkash, R., Kowalik, K., Razeghi, G., Benz, A. P., Belley‐Côté, E. P., Conen, D., Connolly, S. J., TANG, A. S. L., et al. (2024) · JAMA Cardiology · doi:10.1001/jamacardio.2024.0675 · Cited by 78 · see citing works
Atrial Fibrillation–Mediated Cardiomyopathy
Qin, D., MANSOUR, M. C., Ruskin, J. N., & Heist, E. K. (2019) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.119.007809 · Cited by 78 · see citing works
Verhaert, D. V. M., Rocca, H. B., van Veldhuisen, D. J., & Vernooy, K. (2020) · EP Europace · doi:10.1093/europace/euaa368 · Cited by 78 · see citing works
Ganesan, A. N., Nandal, S., Lüker, J., Pathak, R. K., Mahajan, R., Twomey, D., Lau, D. H., & Sanders, P. (2015) · Heart Lung and Circulation · doi:10.1016/j.hlc.2014.09.012 · Cited by 73 · see citing works
“47% of patients) (10, 21-23), pulmonary vein stenosis (six patients, 0.”
BackgroundTzeis, S. E., Gerstenfeld, E. P., Kalman, J. M., Saad, E., Shamloo, A. S., Andrade, J. G., Barbhaiya, C. R., Baykaner, T., Bovéda, S., Calkins, H. G., et al. (2024) · Journal of Arrhythmia · doi:10.1002/joa3.13082 · Cited by 76 · see citing works
Ullah, W., Ling, L., Prabhu, S., Lee, G., Kistler, P. M., Finlay, M., Earley, M. J., Sporton, S. C., Bashir, Y., Betts, T. R., et al. (2016) · EP Europace · doi:10.1093/europace/euv440 · Cited by 71 · see citing works
Efficacy and safety of ablation for people with non-paroxysmal atrial fibrillation
Nyong, J., Amit, G., Adler, A. J., Owolabi, O. O., Perel, P., Prieto‐Merino, D., Lambiase, P. D., Casas, J. P., & Morillo, C. A. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012088.pub2 · Cited by 70 · see citing works
Packer, M. (2019) · European Heart Journal · doi:10.1093/eurheartj/ehz284 · Cited by 71 · see citing works
Simader, F. A., Howard, J. P., Ahmad, Y., Saleh, K., Naraen, A., Samways, J., Mohal, J. S., Reddy, R. K., Kaza, N., Keene, D., et al. (2022) · EP Europace · doi:10.1093/europace/euac173 · Cited by 70 · see citing works
“AF ablation has also been shown to improve echocardiographic measures including LVEF and mitral regurgitation.(13,17) Such measures can be prone to bias in open-label trials, which is why we did not include them in this meta-analysis.”
BackgroundCochet, H., SCHERR, D., Zellerhoff, S., Sacher, F., Derval, N., Denis, A., Knecht, S., Komatsu, Y., Montaudon, M., Laurent, F., et al. (2014) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12449 · Cited by 70 · see citing works
Sethi, N. J., Feinberg, J. B., Nielsen, E. E., Safi, S., Gluud, C. N., & Jakobsen, J. C. (2017) · PLoS ONE · doi:10.1371/journal.pone.0186856 · Cited by 71 · see citing works
Saglietto, A., Ponti, R. D., Biase, L. D., Matta, M., Gaïta, F., Romero, J. E., Ferrari, G. M. D., & Anselmino, M. (2020) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.14429 · Cited by 67 · see citing works
Bunch, T. J., May, H. T., Bair, T. L., Jacobs, V., Crandall, B. G., Cutler, M. J., Weiss, J. P., Mallender, C. D., Osborn, J. S., Anderson, J. L., et al. (2014) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12602 · Cited by 66 · see citing works
Tzeis, S. E., Gerstenfeld, E. P., Kalman, J. M., Saad, E., Shamloo, A. S., Andrade, J. G., Barbhaiya, C. R., Baykaner, T., Bovéda, S., Calkins, H. G., et al. (2024) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-024-01771-5 · Cited by 66 · see citing works
AlTurki, A., Proietti, R., Dawas, A., Alturki, H., Huynh, T. T., & Essebag, V. (2019) · BMC Cardiovascular Disorders · doi:10.1186/s12872-019-0998-2 · Cited by 65 · see citing works
Atrial Fibrillation in Heart Failure: a Therapeutic Challenge of Our Times
Batul, S. A., & Gopinathannair, R. (2017) · Korean Circulation Journal · doi:10.4070/kcj.2017.0040 · Cited by 63 · see citing works
Persistent atrial fibrillation vs paroxysmal atrial fibrillation: differences in management
Margulescu, A. D., & Mont, L. (2017) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2017.1355237 · Cited by 66 · see citing works
“Only three studies have assessed AF ablation (all in persistent AF patients with systolic heart failure) versus rate control [44,45,47].”
BackgroundAblation of Atrial Fibrillation
Link, M. S., Haı̈ssaguerre, M., & Natale, A. (2016) · Circulation · doi:10.1161/circulationaha.116.021727 · Cited by 64 · see citing works
JCS/JHRS 2024 Guideline Focused Update on Management of Cardiac Arrhythmias
Iwasaki, Y., Noda, T., Akao, M., Fujino, T., Hirano, T., Inoue, K., KUSANO, K. F., Nagai, T., Satomi, K., Shinohara, T., et al. (2025) · Circulation Journal · doi:10.1253/circj.cj-24-0073 · Cited by 56 · see citing works
JCS/JHRS 2021 Guideline Focused Update on Non-Pharmacotherapy of Cardiac Arrhythmias
Nogami, A., Kurita, T., KUSANO, K. F., Goya, M., Shoda, M., Tada, H., Naito, S., Yamane, T., Kimura, M., Shiga, T., et al. (2022) · Circulation Journal · doi:10.1253/circj.cj-21-0162 · Cited by 55 · see citing works
Mechanisms and Clinical Significance of Arrhythmia-Induced Cardiomyopathy
Raymond-Paquin, A., Nattel, S., Wakili, R., & Tadros, R. (2018) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2018.07.475 · Cited by 56 · see citing works
Hohendanner, F., Heinzel, F. R., Blaschke, F., Pieske, B. M., Haverkamp, W., Boldt, H., & Parwani, A. S. (2017) · Heart Failure Reviews · doi:10.1007/s10741-017-9657-9 · Cited by 53 · see citing works
“Other studies like CAMTAF [73], ARC-AF [74], or PABA-CHF [75] provided additional evidence that a catheter ablation-based strategy leads to superior quality of life and LVEF improvement.”
ResultAtrial Fibrillation and Heart Failure: Update 2015
Thihalolipavan, S., & Morin, D. P. (2015) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2015.07.004 · Cited by 54 · see citing works
Khan, S. U., Rahman, H., Talluri, S., & Kaluski, E. (2018) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2018.03.003 · Cited by 53 · see citing works
Catheter Ablation for Atrial Fibrillation in Patients With Concurrent Heart Failure
Arora, S., Jaswaney, R., Jani, C., Zuzek, Z., Thakkar, S. J., Patel, H., Patel, M., Patel, N., Tripathi, B., Lahewala, S., et al. (2020) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2020.09.035 · Cited by 53 · see citing works
Nishino, S., Watanabe, N., Ashikaga, K., Morihisa, K., Kuriyama, N., Asada, Y., & Shibata, Y. (2019) · Circulation Cardiovascular Imaging · doi:10.1161/circimaging.119.009317 · Cited by 52 · see citing works
Tsigkas, G., Apostolos, A., Despotopoulos, S., Vasilagkos, G., Kallergis, E. M., Leventopoulos, G., Mplani, V., & Davlouros, P. A. (2021) · Heart Failure Reviews · doi:10.1007/s10741-021-10133-6 · Cited by 51 · see citing works
Atrial fibrillation ablation in heart failure
Richter, S., Biase, L. D., & Hindricks, G. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy778 · Cited by 51 · see citing works
- Authors
- Jones, D. G., Haldar, S. K., Hussain, W., Sharma, R., Francis, D. P., Rahman-Haley, S. L., McDonagh, T. A., Underwood, S. R., Markides, V., & Wong, T.
- Affiliations
- National Health Service (GB)
- Corresponding author
- Wong, Tom
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-05
- Volume
- 61
- Issue
- 18
- Pages
- 1894-1903
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2159999579
- Cited by
- 481
- References
- 44
- Citations by year
- 2026: 16 · 2025: 20 · 2024: 41 · 2023: 36 · 2022: 59 · 2021: 45 · 2020: 41 · 2019: 43 · 2018: 49 · 2017: 37 · 2016: 31 · 2015: 23 · 2014: 26 · 2013: 12 · 2012: 1
- FWCI
- 20.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- St. Jude Medical
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- persistent atrial fibrillation, heart failure, catheter ablation, rate control, peak oxygen uptake, exercise capacity, left ventricular ejection fraction, brain natriuretic peptide, quality of life, 6-minute walk distance, sinus rhythm maintenance, cardiac rehabilitation, heart failure with reduced ejection fraction, heart failure with preserved ejection fraction
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Atrial Fibrillation, Double-Blind Method, Electrocardiography, Female, Follow-Up Studies, Heart Conduction System, Heart Failure, Heart Rate, Humans, Male, Middle Aged, Prospective Studies, Quality of Life, Ventricular Function, Left, Treatment Outcome, Catheter Ablation, Young Adult
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