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Ablation-based rhythm control as effective as rate control in AF and HF

Presented by
Prof. Anthony Tang, University of Ottawa, Canada
Conference
ACC 2021
Trial
RAFT-AF
In patients with both atrial fibrillation (AF) and heart failure (HF), ablation-based rhythm control did not significantly reduce all-cause mortality or HF events when compared with rate control [1].

While catheter ablation offers an alternative to achieving rhythm control and resolving AF, no long-term studies have yet examined its effect on mortality and hospitalisations for HF. To address this gap, the RAFT-AF trial (NCT01420393) used a prospective, randomised, open-label, blinded endpoint (PROBE) design to compare catheter ablation-based AF rhythm control with rate control in participants diagnosed with both HF (stratified for reduced left ventricular ejection fraction [LVEF] of ≤45% or a preserved LVEF of >45%) and AF on the composite endpoint of all-cause mortality or HF events. An HF event was defined as admission to a healthcare facility for >24 hours, a significant worsening of HF requiring intervention, or receiving a previously unplanned intravenous diuretic and increased therapy for chronic HF.

Prof. Anthony Tang (University of Ottawa, Canada) shared the results of RAFT-AF. Participants with both HF and AF (n=411) were randomised to receive either ablation-based AF rhythm control (n=214) or rate control (n=197). Median follow-up period was 37.4 months.

From the 214 patients in the ablation-based rhythm control group, 50 (23.4%) participants reached the primary outcome compared with 64 (32.5%) participants in the rate control group. Although numerically fewer events were present in the ablation group, the difference was not statistically significant (HR 0.71; 95% CI 0.49–1.03; P=0.066) (see Figure).

Figure: Kaplan-Meier curves for the primary outcome of death and HF events in the RAFT-AF study [1]



Secondary outcomes included the Minnesota Living with Heart Failure questionnaire and the Atrial Fibrillation Effects on Quality of Life (AFEQT) scores. Changes from baseline in both scores were improved in both groups, but after adjusting for time and competing cause of death, a greater improvement was observed in the rhythm-control group than in the rate control group. All secondary outcome measures consistently showed the greatest improvement with rhythm control in the subgroup of patients with LVEF ≤45%. Adverse events occurred equally in the 2 groups: 99 patients (50.3%) in the rate control group and 102 patients (47.7%) in the rhythm-control group experienced a serious adverse event.

The safety profiles between these two treatment approaches were similar; approximately 50% from each treatment group experienced one or more serious adverse events. The researchers concluded that while the results demonstrated no statistically significant effect of ablation-based rhythm control over rate-based control in patients with AF and HF as a whole, there did appear to be some trends towards benefit in the LVEF ≤45% subgroup, which would require confirmation in subsequent studies.


    1. Tang A. A randomized ablation-based atrial fibrillation rhythm control versus rate control trial in patients with heart failure and high burden atrial fibrillation (RAFT-AF). ACC 2021 Scientific Session, 15–17 May.

 

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