Ablation Bests Medical Therapy for AFib With Heart Failure
Catheter ablation significantly lowers death rate from any cause, hospitalization for worsening CHF
(HealthDay News) -- Among patients with atrial fibrillation and heart failure, catheter ablation is associated with a significant reduction in a composite end point of death from any cause or hospitalization for worsening heart failure, according to a study published in the New England Journal of Medicine.
Nassir F. Marrouche, MD, from the University of Utah Health in Salt Lake City, and colleagues randomized patients with symptomatic paroxysmal or persistent atrial fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo catheter ablation or medical therapy (179 and 184 patients, respectively) for atrial fibrillation; patients were also treated with guideline-based heart failure therapy.
The researchers found that the primary composite end point of death from any cause or hospitalization for worsening heart failure occurred in significantly fewer patients in the ablation versus the medical therapy group (28.5 versus 44.6%; hazard ratio, 0.62) after a median follow-up of 37.8 months. In the ablation group, significantly fewer patients died from any cause, were hospitalized for worsening heart failure, or died from cardiovascular causes (hazard ratios, 0.53, 0.56, and 0.49, respectively).
"Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy," the authors write.
Several authors disclosed financial ties to pharmaceutical and biomedical technology companies, including Biotronik, which funded the study.
Marrouche NF, Brachmann J, Andresen D, et al. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018; 378:417-427. DOI: 10.1056/NEJMoa1707855
Link MS. Paradigm Shift for Treatment of Atrial Fibrillation in Heart Failure. N Engl J Med 2018; 378:468-469. DOI: 10.1056/NEJMe1714782