Cardiac resynchronization therapy with or without atrioventricular node ablation in atrial fibrillation: the CAAN-AF trial
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND AND AIMS: Patients with heart failure with reduced ejection fraction (HFrEF) derive less benefit from cardiac resynchronization therapy (CRT) if they have coexisting atrial fibrillation (AF). Observational data suggest that atrioventricular node ablation (AVNA) may enhance CRT efficacy in this population. This trial aimed to evaluate the effect of AVNA compared with medical rate control therapy (MRCT) on CRT outcomes in patients with HFrEF and permanent AF. METHODS: The CAAN-AF trial was an international, prospective, multicentre, randomized controlled trial evaluating the impact of AVNA in patients with HFrEF, permanent AF, and CRT-defibrillators (CRT-D). Participants were randomly assigned (1:1) to AVNA or MRCT targeting a resting heart rate <90 bpm. All participants received device optimization. The primary endpoint was a composite of all-cause mortality and nonfatal heart failure events. Secondary endpoints included cardiovascular mortality, unplanned hospitalizations, ventricular arrhythmias requiring device therapy, 6-min walk distance (6MWD), and quality of life. RESULTS: With early termination of the trial due to futility, a total of 143 patients were randomized (67 to AVNA, 76 to MRCT). Baseline characteristics were similar across groups. No significant difference was found in the primary endpoint [47 vs. 46 events; incident rate ratio (IRR), 1.16; 95% confidence interval (CI), 0.60-2.24]. Secondary outcomes, including cardiovascular mortality (odds ratio, 1.93; 95% CI 0.60-6.20), unplanned hospitalizations (IRR, 1.01; 95% CI 0.71-1.74), ventricular arrhythmias requiring device therapy (IRR, 0.68; 95% CI 0.17-2.63), 6MWD, and SF-36 scores, also showed no significant differences. CONCLUSIONS: This randomized trial of patients with permanent AF and CRT-D found no evidence of a reduction in all-cause mortality and nonfatal heart failure events with AVNA compared with MRCT. TRIAL REGISTRATION: NCT01522898.
Source: European Heart Journal
Authors: Prashanthan Sanders, Jonathan P Ariyaratnam, Martin K Stiles, Alexis Puvrez, Stephen J Nicholls, Walter P Abhayaratna, Mark J Perrin, Jeff Alison, Rajeev K Pathak, Anand Ganesan, Vincent Paul, Stuart P Thomas, Gijo Thomas, Melissa E Middeldorp, Elnaz Shahmohamadi, Adrian D Elliott, Robert Park, Haris Haqqani, Dean Boddington, Peter M Kistler, Paul Martin, Raymond W Sy, Stephan Willems, Paul Stobie, Matthew Webber, Gerald Kaye, Paul MacIntyre, Bobby John, Daniel Steven, Azlan Hussin, Suresh Singarayar, David Whalley, David O’Donnell, Nigel Lever, Rajiv Mahajan, Daniel Ninio, John Amerena, Adrian Esterman, Derek P Chew, Matthew Worthley, Andrew Tonkin, Carmine G De Pasquale, Jonathan M Kalman
Institutions: Central Adelaide Local Health Network, Adelaide University, The University of Adelaide, University of Auckland, Monash University, Australian National University, Canberra Hospital, Geelong Hospital, Flinders University, Flinders Medical Centre, Fiona Stanley Hospital, Westmead Hospital, Gold Coast Hospital, Prince Charles Hospital, Tauranga Hospital, The Alfred Hospital, Royal Prince Alfred Hospital, Concord Repatriation General Hospital, Asklepios Klinik St. Georg, Asklepios, Sir Charles Gairdner Hospital, Wellington Hospital, Capital and Coast District Health Board, Princess Alexandra Hospital, Royal Hobart Hospital, Townsville Hospital, University Hospital Cologne, National Heart Institute, Prince of Wales Hospital, Austin Health, Auckland City Hospital, Lyell McEwin Hospital, The University of Melbourne, Melbourne Health
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,922
OpenAlex ID: W7154590322