Circulation. Arrhythmia and electrophysiology · 2026
Optimal Ablation Strategies for Persistent Atrial Fibrillation With Heart Failure: Three-Year Follow-Up of a Prospective Multicenter Randomized Trial.
СтатьяМногоцентровое исследованиеРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Li Kaige, Wang Xinhua, Qin Mu, Ye Ping, Han Bing, Jiang Weifeng, Zhang Yu, Zheng Qidong, Ji Anjing, Zhang Menghe, Wang Yanzhe, Wu Shaohui, Xu Kai, Xu Changhao, Liu Xu, Hou Xumin
Аннотация
BACKGROUND: Catheter ablation has been shown to improve prognosis in patients with heart failure (HF) and atrial fibrillation (AF); however, the optimal ablation strategy remains undefined.
METHODS: In this multicenter, randomized controlled trial, 300 patients with persistent AF and HF, including both HF with reduced ejection fraction (ejection fraction ≤40%) and HF with preserved ejection fraction (ejection fraction >40%, including mid-range ejection fraction [ejection fraction 41% to 50%]), were enrolled and randomized equally to the anatomic-guided ablation, electrogram-guided ablation, and extensive electrogram-anatomic-guided ablation groups, with 100 patients in each group. The coprimary end points were: (1) the composite of cardiovascular death or HF-related hospitalization/urgent visit within 36 months; and (2) maintenance of sinus rhythm at 36 months. Secondary end points included AF burden <1%, New York Heart Association class improvement (≥1 grade), 6-minute walk test change, NT-proBNP (N-terminal pro-B-type natriuretic peptide) reduction, and procedure-related complications. Subgroup analyses were performed for HF with reduced ejection fraction and HF with preserved ejection fraction.
RESULTS: At 36 months, the extensive electro-anatomic-guided ablation group demonstrated the lowest incidence of the composite end point (17.0%) compared with the electrogram-guided ablation (29.0%) and anatomic-guided ablation (36.0%; overall P=0.010) groups, and the highest rate of sinus rhythm maintenance (62.0%) compared with the electrogram-guided ablation (53.0%) and anatomic-guided ablation (44.0%; P=0.039) groups. Consistent improvements were observed for AF burden <1%, New York Heart Association class, 6-minute walk test, and NT-proBNP. Major complications were low and similar across all groups. These trends were consistent in both the HF with reduced ejection fraction and HF with preserved ejection fraction subgroups.
CONCLUSIONS: Electrogram-anatomic ablation provides superior long-term rhythm control, reduces cardiovascular events, and improves symptoms in patients with persistent AF and HF, regardless of ejection fraction.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT07153718.
METHODS: In this multicenter, randomized controlled trial, 300 patients with persistent AF and HF, including both HF with reduced ejection fraction (ejection fraction ≤40%) and HF with preserved ejection fraction (ejection fraction >40%, including mid-range ejection fraction [ejection fraction 41% to 50%]), were enrolled and randomized equally to the anatomic-guided ablation, electrogram-guided ablation, and extensive electrogram-anatomic-guided ablation groups, with 100 patients in each group. The coprimary end points were: (1) the composite of cardiovascular death or HF-related hospitalization/urgent visit within 36 months; and (2) maintenance of sinus rhythm at 36 months. Secondary end points included AF burden <1%, New York Heart Association class improvement (≥1 grade), 6-minute walk test change, NT-proBNP (N-terminal pro-B-type natriuretic peptide) reduction, and procedure-related complications. Subgroup analyses were performed for HF with reduced ejection fraction and HF with preserved ejection fraction.
RESULTS: At 36 months, the extensive electro-anatomic-guided ablation group demonstrated the lowest incidence of the composite end point (17.0%) compared with the electrogram-guided ablation (29.0%) and anatomic-guided ablation (36.0%; overall P=0.010) groups, and the highest rate of sinus rhythm maintenance (62.0%) compared with the electrogram-guided ablation (53.0%) and anatomic-guided ablation (44.0%; P=0.039) groups. Consistent improvements were observed for AF burden <1%, New York Heart Association class, 6-minute walk test, and NT-proBNP. Major complications were low and similar across all groups. These trends were consistent in both the HF with reduced ejection fraction and HF with preserved ejection fraction subgroups.
CONCLUSIONS: Electrogram-anatomic ablation provides superior long-term rhythm control, reduces cardiovascular events, and improves symptoms in patients with persistent AF and HF, regardless of ejection fraction.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT07153718.