CAtheter-Based Ablation of Atrial Fibrillation Compared to Conventional Treatment in Patients With Heart Failure With Preserved Ejection Fraction (CABA-HFPEF)

The objective of CABA-HFPEF is to test whether catheter ablation (CA) for atrial fibrillation (AF) can prevent adverse cardiovascular outcomes in patients with heart failure with preserved (HFpEF) or mildly reduced ejection fraction (HFmrEF).

Study Overview

• Status: Recruiting
• Conditions: Atrial Fibrillation; Heart Failure With Preserved Ejection Fraction; Heart Failure With Mildly Reduced Ejection Fraction
• Intervention / Treatment: Device: CE-marked Catheter Ablation

Detailed Description

HFpEF accounts for approximately half of HF diagnoses and HFmrEF adds another 20%. HFpEF patients are predisposed to AF with a prevalence of AF up to 65%. Conversely, the presence of AF increases the likelihood of subsequent HFpEF by up to 4-fold across diverse populations. The vulnerable hemodynamic state in HFpEF patients due to LV diastolic dysfunction can be significantly affected by AF with loss of atrial contraction and reduction in cardiac output. Thus, presence of AF in HFpEF patients leads to a significant increase in hospitalization, mortality and stroke.

Restoring and maintaining sinus rhythm in patients with HFpEF and AF could reduce cardiovascular (CV) outcomes. Catheter ablation (CA), particularly when performed as initial rhythm control, results in less recurrences of AF than anti arrhythmic drug therapy. In patients with HF with reduced ejection fraction (HFrEF) and AF, CA showed a significant reduction in all-cause mortality and worsening HF admissions compared to medical therapy.

No randomized clinical trial has tested or is currently testing the effects of CA on CV outcomes in patients with HFmrEF or HFpEF and AF. To address this, CABA-HFPEF tests whether CA can improve CV outcomes compared to usual care in these patients. The results of CABA-HFPEF will critically extend the current evidence on ablation-based rhythm control to this large population in dire need for treatments that improve clinical outcomes.

• Study Type: Interventional
• Enrollment (Anticipated): 1548
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Abdul Parwani, Dr.; Phone Number: +4930450565383; Email: caba_hfpef@charite.de

Study Locations

• Germany
  • Berlin, Germany, 13353
    • Recruiting
    • Charité University Medicine Berlin, Campus Virchow Klinikum
    • Contact: Abdul Parwani, Dr.; Phone Number: 004930450565383; Email: caba_hfpef@charite.de

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 90 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

INCLUSION CRITERIA:

1. Age ≥18 years
2. Signed written informed consent
3. Clinical evidence of symptomatic heart failure (NYHA Class II-III)
4. Paroxysmal or persistent atrial fibrillation (less than 24 months after first diagnosis, documented at least on one 12-lead ECG)

5. Left ventricular ejection fraction (LVEF) 40-49%

   OR

   LVEF ≥ 50% with at least one of the following HFpEF echocardiography findings (any local measurement made during the screening epoch):

   A. LA enlargement defined by at least 1 of the following: LA width (diameter) ≥3.8 cm or LA length ≥5.0 cm or LA area ≥20 cm2 or LA volume ≥55 ml or LA volume index ≥29 ml/m2

   B. Left ventricular hypertrophy (septal thickness or posterior wall thickness ≥1.1 cm or relative wall thickness >0.42)

6. Patients with at least 1 of the following:

A. HF hospitalization (defined as HF listed as the major reason for hospitalization) within 6 months prior to screening visit and NT-proBNP >200 pg/ml for patients in sinus rhythm (SR) or >600 pg/ml for patients in AF at the time of blood sampling

B. NT-proBNP >300 pg/ml for patients in SR or >900 pg/ml for patients in AF on screening ECG

EXCLUSION CRITERIA:

1. Patient is unable or unwilling to provide infomed consent
2. Patient is not suitable for rhythm control of AF
3. Previous left atrial CA or surgical therapy of AF
4. Acutely decompensated HF, NYHA IV (patients can be enrolled after stabilization)
5. Valvular heart disease needing interventional or surgical treatment within 3 months
6. Heart surgery planned within 3 months
7. Prior heart transplant or listed for heart transplant or cardiac assist device implantation
8. Untreated hypothyroidism or hyperthyroidism (after successful treatment of thyroid dysfunction, patients may be enrolled)
9. Patient has absolute contra-indication to oral anticoagulation
10. Any disease that limits life expectancy to less than 1 year
11. Active systemic infection (after successful treatment of infection, patients may be enrolled)
12. Women currently pregnant or breastfeeding or women of childbearing potential without highly effective contraception (PEARL-Index < 1%)
13. Patient is included in another clinical trial
14. Inability to comply with the study procedures

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Catheter Ablation; Symptomatic HFmrEF or HFpEF patients with AF that meet I/E criteria will be randomized 1:1 to receive either CA or usual medical care without the aim of CA. Patients assigned to rhythm control group will be treated with catheter ablation as first line therapy to restore and maintain sinus rhythm, additionally to the therapeutic recommendations of the current ESC guidelines for the management of atrial fibrillation (AF) and the current ESC Heart Failure (HF) guidelines.	Device: CE-marked Catheter Ablation; Once patients have been randomized to the catheter ablation (CA) group, the ablation procedure must be performed within 4 weeks. CA will initially aim at pulmonary vein isolation.
No Intervention: Usual Medical Care; Symptomatic HFmrEF or HFpEF patients with AF that meet I/E criteria will be randomized 1:1 to receive either CA or usual medical care without the aim of CA. Subjects randomized to usual care will be treated according to current ESC guidelines for the management of AF and current ESC HF guidelines. Usual care of AF in the context of CABA-HFPEF consists of an initial treatment limited to rate control in addition to adequate antithrombotic therapy, typically oral anticoagulation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The primary outcome is defined as a composite of cardiovascular death, stroke and total (first and recurrent) unplanned cardiovascular hospitalization for heart failure or acute coronary syndrome.	Estimated first patient in to last patient out 48 months.

Secondary Outcome Measures

Outcome Measure	Time Frame
Cardiovascular death	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months
All-cause mortality	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months
Unplanned hospitalization for atrial arrhythmia	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months
Total (first and recurrent) planned and unplanned cardiovascular hospitalizations	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months
Stroke	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months
Total (first and recurrent) unplanned cardiovascular hospitalization for heart failure or acute coronary syndrome	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months
Nights spent in hospital	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months
Days alive and out of hospital	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months
Atrial fibrillation burden (percentage of AF at 12 months FU Holter ECG)	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months
Change in left ventricular ejection fraction at 12 months FU	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months
Change in NYHA class at 12 months FU	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months
Change in EHRA score at 12 months FU	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months
Change in quality of life at 12 months FU	The secondary endpoints will be documented for at least 12 months following randomization. Estimated first patient in to last patient out 48 months

Collaborators and Investigators

• Sponsor: Charite University, Berlin, Germany
• Collaborators: Boston Scientific Corporation; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK); Kompetenznetz Vorhofflimmern e.V. (AFNET)
• Investigators: Study Chair: Paulus Kirchhof, Prof. Dr., Director Department of Cardiology, Heart and Vascular Center University Hamburg Eppendorf; Study Chair: Stefan Kääb, Prof. Dr., Department of Cardiology, Ludwig-Maximilians-University Hospital Munich; Study Chair: Tim Friede, Prof. Dr., Departement of Medical Statistics, University Medical Center Göttingen; Study Chair: Roland Tilz, Prof. Dr., Head of Electrophysiology Department, University Hospital Lübeck; Principal Investigator: Abdul Parwani, Dr., Head of Electrophysiology; Charité University Medicine Berlin, CVK; Study Chair: Burkert Pieske, Prof. Dr., Independent

Study record dates

Study Major Dates

• Study Start (Anticipated): March 1, 2023
• Primary Completion (Anticipated): July 1, 2026
• Study Completion (Anticipated): July 1, 2027

Study Registration Dates

• First Submitted: August 10, 2022
• First Submitted That Met QC Criteria: August 17, 2022
• First Posted (Actual): August 19, 2022

Study Record Updates

• Last Update Posted (Estimate): March 6, 2023
• Last Update Submitted That Met QC Criteria: March 3, 2023
• Last Verified: March 1, 2023

More Information

Terms related to this study

• Keywords: atrial fibrillation; heart failure; catheter ablation; medial therapy
• Additional Relevant MeSH Terms: Pathologic Processes; Heart Diseases; Cardiovascular Diseases; Arrhythmias, Cardiac; Heart Failure; Atrial Fibrillation
• Other Study ID Numbers: CABA-HFPEF-DZHK27

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No