EP News: Clinical

Abstract

Parkash et al (Circulation 2022;145:1693, PMID 35313733) conducted a multicenter, open-label trial randomizing patients with paroxysmal (>4 episodes in 6 months) or persistent (duration <3 years) AF, New York Heart Association class II-III heart failure (HF), and elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) to ablation-based rhythm control or rate control. The primary outcome was a composite of all-cause mortality and all HF events. Secondary outcomes included left ventricular ejection fraction (LVEF), 6-minute walk test, and NT-proBNP. Overall, 411 patients were randomized to ablation (n = 214) or rate control (n = 197). The primary outcome occurred in 50 patients (23.4%) in the ablation group and 64 patients (32.5%) in the rate control group (hazard ratio 0.71; P = .066). LVEF increased in the ablation group (10.1% ± 1.2% vs 3.8% ± 1.2%; P = .017); 6-minute walk distance improved (44.9 ± 9.1 m vs 27.5 ± 9.7 m; P = .025) and NT-proBNP decreased (−77.1% vs −39.2%; P < .0001). Adverse events were observed in 50% of patients in both groups. The authors conclude that there was no statistical difference in all-cause mortality or HF events with ablation-based rhythm control vs rate control. There was a nonsignificant trend for improved outcomes with ablation-based rhythm control over rate control.