CAtheter-Based Ablation of atrial fibrillation compared to conventional treatment in patients with Heart Failure with Preserved Ejection Fraction (CABA-HFPEF-DZHK27)

Patients with heart failure often also suffer from atrial fibrillation. Their heart then beats irregularly and often too fast, worsening their heart failure. Those affected often have to be hospitalized. The CABA-HFPEF-DZHK2 study, funded by the German Center for Cardiovascular Research, investigates whether catheter ablation can improve patients' condition and thus reduce mortality, strokes, and hospitalizations.

Around 2.5 million people in Germany are affected by heart failure, and more than one million of these patients also suffer from atrial fibrillation in this context. At first, atrial fibrillation often occurs in episodes. In any case, the disease should be recognized and treated, otherwise, it becomes permanent and increases the risk of stroke.

It used to be assumed that atrial fibrillation could cause heart failure, a condition known as tachycardiomyopathy. Today, it is known that the reverse can also occur, namely that heart failure triggers atrial fibrillation. The often rapid and irregular heartbeat that then occurs, in turn worsens the heart failure - a vicious circle begins. To counteract this dangerous combination of heart failure and atrial fibrillation, DZHK scientists are investigating in the CABA-HFPEF-DZHK27 study whether treatment of atrial fibrillation by so-called catheter ablation helps heart failure patients and has a positive effect on their state of health and prognosis. The study focuses on heart failure patients with preserved or only mildly reduced ejection fraction (Heart Failure with Preserved Ejection Fraction, HFPEF, and Heart Failure with mildly reduced Ejection Fraction, HFmrEF).

Atrial fibrillation can be treated either with medication or with catheter ablation. This involves using an ablation catheter to obliterate the heart tissue disrupting the rhythm. Smaller observational studies have already shown that catheter ablation achieves better results in heart failure patients with atrial fibrillation than drug treatment. The quality of life improves, patients can perform better again and need to be hospitalized less often.

CABA-HFPEF-DZHK27 is now the first large, multicenter study to investigate this relationship. Across Europe, 60 centers are participating, and 1,550 patients with predefined inclusion and exclusion criteria are expected to participate through the centers. The study is designed to last five years.

Publications

Catheter-based ablation to improve outcomes in patients with atrial fibrillation and heart failure with preserved ejection fraction: Rationale and design of the CABA-HFPEF-DZHK27 trial. Parwani, A. S. et al. Eur J Heart Fail. 2024 Jul 18. doi: 10.1002/ejhf.3373. Epub ahead of print.

Principal Investigators

Principal investigator: Abdul S. Parwani (Berlin), Co-PI: Paulus Kirchhof (Hamburg), Stefan Kääb (München), Roland R Tilz (Lübeck), Tim Friede (Göttingen), Burkert Pieske