Cutting-Edge Rhythmology Trials Offer New Hope for AF,HF Patients
Hamburg,Germany – Several pivotal clinical trials are underway across Europe,poised to reshape the treatment landscape for atrial fibrillation (AF) and heart failure (HF),as presented at a preview of studies to be highlighted at the upcoming DGK Heart Days 2025. These investigations range from optimizing anticoagulation strategies to evaluating the potential of catheter ablation as a proactive therapy, offering potential benefits for a wide range of patients.
One key study, REACT AF, led by Dr. Maura M. Zylla of the heidelberg Center for Cardiac Arrhythmias, is currently recruiting participants to test the non-inferiority of time-limited oral anticoagulation around the time of AF diagnosis. Beyond confirming efficacy, the trial aims to demonstrate a reduction in bleeding events – a critical secondary endpoint.
For patients battling both heart failure and AF, the CABA HFpEF trial (doi: 10.1002/ejhf.3373) is investigating whether catheter ablation can outperform standard drug therapy. PD Dr. Abdul S. Parwani from the German Heart Center at Charité Berlin highlighted the meaningful overlap between these conditions, noting that “almost half of our heart failure patients also suffer from atrial fibrillation,” with prevalence reaching up to 60% in HFpEF patients. This multicenter study will enroll 1,548 subjects across 72 European locations,with a median follow-up of 36 months,and will assess improvements in health,hospital stays,stroke risk,and mortality. All participants will continue to receive standard heart failure medication alongside their assigned treatment (ablation or medical therapy).
The EASThigh study is tackling a different question: can early catheter ablation improve outcomes for AF patients with significant comorbidities? Led by Prof. Dr. Andreas Rillig of University Hospital Hamburg Eppendorf UKE, the trial will compare early ablation to usual treatment in patients with a CHA2DS2-VA score of ≥4, focusing on reducing the incidence of stroke, cardiovascular death, and heart failure. The first patient was enrolled on October 14, 2024, with completion anticipated in 2030. Participants must be suitable candidates for ablation using a Medtronic cryoballoon system.
CASTLE VT (doi: 10.1002/ejhf.3512) is exploring a preventative approach to ventricular arrhythmias in patients with end-stage heart failure. This investigator-initiated, single-center study, led by Prof. Dr. Christian Sohns of the Heart and Diabetes Center NRW in Bad Oeynhausen, will compare preventative catheter ablation to medical therapy, aiming to improve outcomes related to mortality, the need for LVAD implantation, and emergency heart transplantation. Currently, 68 of the planned 160 patients with ischemic cardiomyopathy (LVEF <35%, NYHA class ≥3) have been randomized, with researchers anticipating full enrollment within the next year and a half.
These trials, to be further discussed at the DGK Heart days 2025 (October 25-27, 2025, Congress Center Hamburg CCH), represent a significant push towards more effective and personalized treatment strategies for patients living with arrhythmias and heart failure.
