Atrial fibrillation ablation is associated with lower rates of death, urgent heart transplantation or left ventricular assist device (LVAD) implantation compared with medical therapy in patients with end-stage heart failure, according to late breaking research presented in a Hot Line session today at ESC Congress 2023.
Patients with end-stage heart failure eligible for heart transplantation have been excluded from major trials, leaving them with no recommendations or evidence for the optimal treatment of atrial fibrillation and advanced heart failure. There is uncertainty around the application of guidelines in this group and many novel advances in heart failure therapy are withheld in clinical practice.
The trial enrolled patients with symptomatic atrial fibrillation and end-stage heart failure who were eligible for heart transplantation according to criteria from the ESC and the International Society for Heart and Lung Transplantation . Patients were in New York Heart Association functional class II, III, or IV, had a left ventricular ejection fraction of 35% or below and were fitted with a cardiac device for continuous monitoring.
The study included 194 patients. The average age of participants was 64 years and 19% were women. The study was stopped for efficacy by the Data Safety Monitoring Board one year after randomisation was completed.
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