Marrouche NF, et al. - Catheter ablation vs medical therapy was tested as a treatment option for atrial fibrillation in patients already receiving guidelines-based therapy for heart failure. Compared with medical therapy, catheter ablation was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure in this patient population.

• Researchers randomly assigned 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 either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure.
• All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator.
• A composite of death from any cause or hospitalization for worsening heart failure was the primary end point.

• Findings demonstrated that after a median follow-up of 37.8 months, the occurrence of the primary composite end point was reported in significantly fewer patients in the ablation group than in the medical-therapy group (51 patients [28.5%] vs 82 patients [44.6%]; hazard ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.87; P=0.007).
• Researchers found that significantly fewer patients died from any cause in the ablation group (24 [13.4%] vs 46 [25.0%]; hazard ratio, 0.53; 95% CI, 0.32 to 0.86; P=0.01), were hospitalized for worsening heart failure (37 [20.7%] vs 66 [35.9%]; hazard ratio, 0.56; 95% CI, 0.37 to 0.83; P=0.004), or died from cardiovascular causes (20 [11.2%] vs 41 [22.3%]; hazard ratio, 0.49; 95% CI, 0.29 to 0.84; P=0.009).