AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial
Errata to this article were published (Eur Heart J, 7 Dec 2021 ↗ · 3 Feb 2022 ↗)
Primary resultResult — go to the resultHazard ratio 0.26 95% CI 0.10–0.65- stopped for efficacy at interim analysis
- Trial stopped for efficacy at interim analysis after a median of 29 months of follow-up
Authors' conclusion
Ablation + CRT was superior to pharmacological therapy in reducing mortality in patients with permanent AF and narrow QRS who were hospitalized for HF, irrespective of their baseline EF.
Study context
- Population
- Severely symptomatic permanent atrial fibrillation (AF) >6 months, narrow QRS (≤110 ms) and ≥1 heart failure (HF) hospitalization in the previous year
- Participants
- 133 participants
- Comparison
- AV junction ablation + CRT vs pharmacological rate control
- Primary endpoint
- All-cause mortality
Methodological detailsinternational, open-label, blinded outcome
- International
- Open-label
- Blinded outcome
Primary result
As reported in the abstract
median 29 months follow-up
Hazard ratio
0.26
95% CI 0.10–0.65
P = 0.004
Events by treatment group
Ablation + CRT vs Drug
HR 0.26 (95% CI 0.10–0.65); P = 0.004
Secondary outcomes
Estimated death rate · 2 years
Estimated death rate · 4 years
| Outcome | Ablation + CRT | Drug | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| All-cause mortality or HF hospitalization | 29% | 51% | 0.40 (0.22–0.73) | P = 0.002 | |
| 0.20.5125Hazard ratio (log scale) |
All-cause mortality, by ejection fraction (EF) ≤35% vs >35% (subgroup)
- Benefit of Ablation + CRT similar in EF ≤35% and >35%
Original publication
AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial. Eur Heart J. Published 28 August 2021. doi:10.
Summarised from the published abstract; every number is checked against it