Treating Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction: Ablation or Medication

NCT ID: NCT07272902

Last Updated: 2025-12-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

84 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-12-31

Study Completion Date

2027-10-31

Brief Summary

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This study is testing two different ways of treating atrial fibrillation (AF) in people who also have heart failure with mildly reduced or preserved heart function. Patients will randomly be assigned to either rhythm control using catheter ablation or rate control using medicines. The pilot phase will determine if a larger study can be successfully carried out to see which approach better improves survival, reduces hospitalizations, and enhances quality of life.

Detailed Description

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Conditions

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Atrial Fibrillation (AF) Heart Failure With Mildly Reduced Ejection Fraction Heart Failure With Preserved Ejection Fraction (HFPEF) Rate Control Rhythm Control

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This trial is a pilot feasibility trial intended to lead into a larger, definitive trial as the trial is comparing two treatments already in clinical use.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Catheter Ablation (Rhythm Control Group)

Participants in this group will undergo catheter ablation procedure, scheduled within 4 weeks of joining the study.

Group Type ACTIVE_COMPARATOR

Catheter Ablation for Atrial Fibrillation

Intervention Type PROCEDURE

Participants randomized to this arm will undergo catheter ablation within 4 weeks of randomization. Pulmonary vein isolation is required; additional ablation strategies may be applied at investigator discretion. Guideline-directed medical therapy for atrial fibrillation and heart failure will also be provided.

Medical Therapy (Rate Control Group)

Participants in this group will take medications, with the dosages adjusted over the first few weeks to find the correct dosage.

Group Type ACTIVE_COMPARATOR

Rate Control Medications (beta-blockers, calcium channel blockers, digoxin)

Intervention Type DRUG

Participants randomized to this arm will receive pharmacologic therapy to achieve guideline-recommended heart rate control (resting HR \<80 bpm, \<110 bpm with exercise). Therapy may include beta-blockers, non-dihydropyridine calcium channel blockers, or digoxin. If adequate control is not achieved with medication, AV nodal ablation and pacing may be used. Guideline-directed medical therapy for atrial fibrillation and heart failure will also be provided.

Interventions

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Catheter Ablation for Atrial Fibrillation

Participants randomized to this arm will undergo catheter ablation within 4 weeks of randomization. Pulmonary vein isolation is required; additional ablation strategies may be applied at investigator discretion. Guideline-directed medical therapy for atrial fibrillation and heart failure will also be provided.

Intervention Type PROCEDURE

Rate Control Medications (beta-blockers, calcium channel blockers, digoxin)

Participants randomized to this arm will receive pharmacologic therapy to achieve guideline-recommended heart rate control (resting HR \<80 bpm, \<110 bpm with exercise). Therapy may include beta-blockers, non-dihydropyridine calcium channel blockers, or digoxin. If adequate control is not achieved with medication, AV nodal ablation and pacing may be used. Guideline-directed medical therapy for atrial fibrillation and heart failure will also be provided.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Age ≥18 years
* Diagnosis of atrial fibrillation (documented on Holter, rhythm strip, or ECG)
* New York Heart Association (NYHA) class II-III heart failure
* Left ventricular ejection fraction (LVEF) \>40%
* Meet specific NT-proBNP criteria:
* If HF hospitalization within 6 months prior to screening: NT-proBNP \>200 pg/ml (if not in AF at screening) or \>600 pg/ml (if in AF at screening)
* Otherwise: NT-proBNP \>300 pg/ml (if not in AF at screening) or \>900 pg/ml (if in AF at screening)
* On stable guideline-directed medical therapy for ≥1 month
* On stable diuretic dose for ≥2 weeks
* Suitable for either ablation-based rhythm control or rate control strategy

Exclusion Criteria

* Permanent atrial fibrillation diagnosis
* Prior catheter ablation for atrial fibrillation
* NYHA class IV heart failure
* Rheumatic heart disease
* Moderate or severe mitral stenosis
* Mechanical mitral valve
* Severe aortic stenosis or severe aortic/mitral regurgitation
* Renal failure requiring dialysis
* Contraindication to oral anticoagulation
* Infiltrative cardiomyopathies
* Complex congenital heart disease
* Untreated thyroid disease
* Acute coronary syndrome or coronary artery bypass surgery within 12 weeks
* Participation in another clinical trial
* Inability to provide informed consent
* Other serious non-cardiovascular condition with life expectancy ≤1 year
* Age \<18 years
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Heart and Stroke Foundation of Canada

OTHER

Sponsor Role collaborator

Nova Scotia Health Authority

OTHER

Sponsor Role lead

Responsible Party

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Ratika Parkash

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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QEII HSC

Halifax, Nova Scotia, Canada

Site Status

Countries

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Canada

Central Contacts

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Laura Hamilton, BSC, MAHSR

Role: CONTACT

902-473-7226

Katie Kawulka, BScN, RN

Role: CONTACT

902-473-7684

Facility Contacts

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Laura Hamilton, BSC, MAHSR

Role: primary

902-473-7226

Katie Kawulka, BScN, RN

Role: backup

902-473-7684

Other Identifiers

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1032000

Identifier Type: OTHER

Identifier Source: secondary_id

CABANA-RAFT HF

Identifier Type: -

Identifier Source: org_study_id

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