Ablation versus medication for atrial fibrillation in people with preserved or mildly reduced heart function
A Randomized Ablation-based Atrial Fibrillation Rhythm Control Versus Rate Control Trial in Patients With Heart Failure and Preserved Ejection Fraction (CABANA-RAFT HF): A Pilot Study
This trial will randomly assign adults with atrial fibrillation and heart failure with preserved or mildly reduced ejection fraction to either catheter ablation (rhythm control) or medications for rate control to see which approach leads to better survival, fewer hospital stays, and improved quality of life.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 84 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | Nova Scotia Health Authority Academic / other |
| Locations | 1 site (Halifax, Nova Scotia) |
| Trial ID | NCT07272902 on ClinicalTrials.gov |
What this trial studies
This randomized pilot trial enrolls adults with atrial fibrillation and heart failure with preserved or mildly reduced ejection fraction (LVEF >40%) and NYHA class II–III symptoms, assigning them to rhythm control with catheter ablation or rate control with medications such as beta-blockers, calcium channel blockers, or digoxin. The pilot phase will test feasibility and gather preliminary outcome data on survival, heart failure hospitalizations, and patient-reported quality of life to inform a larger definitive trial. Key eligibility includes documented AF, elevated NT-proBNP according to screening criteria, and stable guideline-directed medical therapy and diuretic dosing. The trial is run at the QEII Health Sciences Centre in Halifax, Nova Scotia, with oversight from the Nova Scotia Health Authority and the Heart and Stroke Foundation of Canada.
Who should consider this trial
Good fit: Adults (≥18) with documented atrial fibrillation, LVEF >40%, NYHA class II–III heart failure who meet the NT-proBNP thresholds, are on stable guideline-directed medical therapy and diuretics, and are considered suitable for either ablation or medical rate control are ideal candidates.
Not a fit: Patients with permanent atrial fibrillation, prior AF ablation, NYHA class IV heart failure, significant valvular disease (including moderate–severe mitral stenosis or a mechanical mitral valve), or severe renal failure are excluded and unlikely to benefit from participation.
Why it matters
Potential benefit: If successful, the trial could identify whether ablation or medication-based rate control provides longer survival, fewer hospitalizations, and better quality of life for patients with AF and HFpEF or mildly reduced EF.
How similar studies have performed: Randomized trials in HFrEF and broader AF populations have shown benefits of catheter ablation in some settings, but randomized data specifically comparing ablation versus rate control in HFpEF are limited, so this question remains partly novel.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Age ≥18 years * Diagnosis of atrial fibrillation (documented on Holter, rhythm strip, or ECG) * New York Heart Association (NYHA) class II-III heart failure * Left ventricular ejection fraction (LVEF) \>40% * Meet specific NT-proBNP criteria: * If HF hospitalization within 6 months prior to screening: NT-proBNP \>200 pg/ml (if not in AF at screening) or \>600 pg/ml (if in AF at screening) * Otherwise: NT-proBNP \>300 pg/ml (if not in AF at screening) or \>900 pg/ml (if in AF at screening) * On stable guideline-directed medical therapy for ≥1 month * On stable diuretic dose for ≥2 weeks * Suitable for either ablation-based rhythm control or rate control strategy Exclusion Criteria: * Permanent atrial fibrillation diagnosis * Prior catheter ablation for atrial fibrillation * NYHA class IV heart failure * Rheumatic heart disease * Moderate or severe mitral stenosis * Mechanical mitral valve * Severe aortic stenosis or severe aortic/mitral regurgitation * Renal failure requiring dialysis * Contraindication to oral anticoagulation * Infiltrative cardiomyopathies * Complex congenital heart disease * Untreated thyroid disease * Acute coronary syndrome or coronary artery bypass surgery within 12 weeks * Participation in another clinical trial * Inability to provide informed consent * Other serious non-cardiovascular condition with life expectancy ≤1 year * Age \<18 years
Where this trial is running
Halifax, Nova Scotia
- Qeii Hsc — Halifax, Nova Scotia, Canada (Recruiting)
Study contacts
- Study coordinator: Laura Hamilton, BSC, MAHSR
- Email: laura.hamilton@nshealth.ca
- Phone: 902-473-7226
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.