While treatment for most patients with atrial fibrillation (AF) in heart failure (HF) with reduced ejection fraction is predominantly rate control, there is potential to markedly increase the use of catheter ablation in this population, a new study found. Findings from the AATAC (Ablation versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients with congestive heart failure and an implantable device) trial from 2013-2014 suggest that catheter ablation may benefit these patients, although significant differences in clinical profiles may influence ablation outcomes in practice. Researchers found:

• From 164,166 patients with AF and HF, 8,483 (7%) patients potentially met AATAC inclusion criteria.
• Eligible individuals were older (mean age 71.2 ±11.4 years) and had greater comorbidity (coronary artery disease 79.2%, hypertension 82.4%, and diabetes mellitus 31.8%) compared to AATAC trial participants.
• AF was predominantly paroxysmal (65.5%), rather than persistent/permanent or new onset; whereas all patients in the AATAC trial had persistent AF.
• Rhythm control with anti-arrhythmic drugs was reported in 29.0% of AATAC eligible patients and 9.3% had undergone catheter ablation.
• Patients who underwent ablation were more likely to be younger and have less comorbidities than those who did not.