Reviwer : Dr. Oğuzhan Birdal

Name of the study : A Randomized Ablation-based atrial Fibrillation rhythm control versus rate control Trial in patients with heart failure and high burden Atrial Fibrillation (RAFT –AF)

Published congress : ACC 2021

Full text link :-

Background :  
Heart failure (HF) and atrial fibrillation (AF) often coexist and are associated with increased morbidity and mortality. Treatment of AF with catheter ablation in HF patients has been shown to have favorable outcomes compared with amiodarone, but more data are needed to compare this with rate control.

Objective :
The aim of the study was to compare the safety and effectiveness of catheter ablation-based rhythm control with rate control in the treatment of patients with AF and HF. In this study, it was investigated whether ablation-based rhythm control reduces all-cause mortality and HF-related events versus rate control in patients with HF with preserved ejection fraction and low ejection fraction accompanied by AF..

Methods :
RAFT-AF was designed as a multicenter, prospective, randomized, single-blind study. Patients were randomized 1:1 to either catheter ablation (n = 214) or drug therapy (n = 197) arms. The follow-up period was 37.4 months. The mean patient age was 67, and 25% of the patient population was female. The primary composite endpoint of the study was time to death or heart failure events, while the secondary endpoints were death, HF-related events, changes in left ventricular ejection fraction, NT-proBNP levels, six-minute walk distance, and quality of life over 12-24 months

Results :
The study was terminated prematurely due to concerns about futility. The primary composite endpoint, time to death or HF-related events, was not statistically different between the rhythm and rate control groups (23.4% vs. 32.5%, [HR] 0.71, 95%[CI] 0.49-1.03, p = 0.066). On the secondary endpoints, statistically significant results were obtained in favor of rhythm control.

Conclusion :
When ablation-based rhythm control and rate control were compared, no statistically significant difference was found in the reduction of all-cause deaths and HF-related events. Compared to the rate control group, the rhythm control group had greater increases in left ventricular functions, more improvement in quality of life, and a greater decrease in NT-pro BNP levels. There were no significant differences in serious adverse events in either group.

Interpretation :
As in some previous studies, when ablation-based rhythm control and rate control were compared, the events related to death and HF were found to be statistically similar in both groups, but numerically, it was determined that the events were less common in the rhythm control group. Secondary endpoints also favored rhythm control. However, there are still insufficient data on the conversion of AF to sinus rhythm in HF patients. Future studies may change our clinical practice.