Active Heart, Stroke & Blood Lungs & Breathing

Cryoballoon/Radiofrequency/Pulsed Field Ablation of Atrial Fibrillation versus Medical Treatment for Heart Failure: CRAAFT-HF.

Funder BHF Charity-funded
Recipient organisation University College London
Funding £1.6M
Period Nov 2024 — Nov 2030

In plain English

AI plain-English summary

A 1,200-patient clinical trial will test whether restoring normal heart rhythm with catheter ablation can reduce deaths and hospitalisations in people with both heart failure and atrial fibrillation. Atrial fibrillation—a rapid, irregular heartbeat—makes heart failure worse and more deadly. Small studies suggest that ablation, which uses a cryo-balloon or radiofrequency energy to isolate the pulmonary veins, improves heart function and exercise tolerance. But the only trial to show a mortality benefit enrolled just 363 highly selected patients with implanted defibrillators, and the reported reduction in deaths was far larger than what would be expected in a typical heart failure population. No study has yet answered the question for the general heart failure patient. If this trial shows that ablation plus medical therapy cuts mortality and hospitalisations compared to medical therapy alone, it could change standard care for hundreds of thousands of UK patients. The procedure is already widely used for atrial fibrillation alone; proving it also saves lives in heart failure would give clinicians a clear, evidence-based reason to offer it earlier and more broadly. The results could also reduce the burden on the NHS from repeated hospital admissions for decompensated heart failure.

View original technical description
Atrial fibrillation (AF) promotes the severity & mortality of heart failure. Numerous small studies have shown that restoration of sinus rhythm by catheter ablation in patients with heart failure improves left ventricular function and exercise tolerance. AF ablationisperformed very effectively and efficiently using a cryo-balloon or radio-frequency ablation pulmonary vein isolation (PVI) technique. One small trial (n=363) in ICD and CRT recipients (CASTLE-AF) reported a mortality benefit of AF ablation but the patients were highly selected and the mortality reduction far higher than real world expected differences. No studies have investigated the mortality benefit in a general heart failure population. This study is designed as a randomised, open label multicentre clinical trial in which PVI and medical therapy is compared to medical therapy alone in patients with heart failure with reduced ejection fraction (<​50%) and paroxysmal or persistent AF to determine if this reduces mortality and hospitalisations as well as improving quality of life. By utilising the clinical and research networks of the British Heart Failure Society and British Heart Rhythm Society we aim to recruit 1200 patients to definitively address this question in the typical heart failure population with AF by interrupting the maintenance of AF.

View the original record at the funder ↗

Researchers

Pier Lambiase (EPMC Awardee)

Related Research

Grants with similar aims, by meaning.

Cryoballoon Radiofrequency ablation of atrial fibrillation versus medical treatment for heart failure
CRAAFT-HF: Cryoballoon/Radiofrequency Ablation of Atrial Fibrillation versus Medical Treatment for Heart Failure
Developing Dynamic Substrate Targeted Personalised Treatment Strategies in AF.
Application of Deep Learning to Predict Optimal Ablation Therapy for Atrial Fibrillation from Magnetic Resonance Imaging Data
Rhythm or rate control for CRT: the RHYTHMIC study

Original classification

None

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