Ablation could be ‘a powerful new strategy’ for treating heart failure patients with atrial fibrillation

Catheter ablation is a more beneficial treatment option for heart failure patients with atrial fibrillation (AFib) than standard antiarrhythmic drug therapy, according to new findings published in Circulation.

“AFib and heart failure often occur in the same patients and have a complex, incompletely understood interrelationship,” wrote lead author Douglas L. Packer, MD, of Mayo Clinic Hospital in Rochester, Minnesota, and colleagues. “In particular, while they have common antecedents, each also appears to promote development and progression of the other.”

To learn more about treating patients with both heart failure and AFib, Packer and colleagues examined data from 778 adults who participated in the CABANA trial. A majority of participants had preserved systolic function.

Each patient had heart failure and AFib, and the participants were randomly chosen to either undergo catheter ablation or drug therapy. The trial’s primary endpoint was a composite of all-cause mortality, disabling stroke, serious bleeding events or sudden cardiac arrest. Researchers also tracked other trends, including various measures related to quality of life and hospitalizations specifically related to heart failure.

Overall, ablation was associated with numerous benefits over standard drug therapy. Patients who underwent ablation had lower all-cause mortality, for instance, as well as improvements in both AFib recurrence and AFib burden. In addition, the authors noted, ablation parents “demonstrated substantial and sustained improvements in quality of life out to five years.” There was little difference in heart failure hospitalizations.

The team did write about some of the study’s limitations. Each heart failure diagnosis could not be diagnostically confirmed, the authors wrote, and baseline echocardiography findings were not available for each participant.

Even with these things in mind, however, the data still suggest that catheter ablation shows potential to be a safe, effective treatment option for heart failure patients with AFib.  

“If these findings can be confirmed in adequately sized replication trials, clinicians would have a powerful new strategy for reducing the patient suffering and premature mortality that result when AFib and heart failure occur together,” the authors concluded.

Read the full study here.