Cardiac resynchronization therapy with or without atrioventricular node ablation in atrial fibrillation: the CAAN-AF trial

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.

Authors

Institutions

Publication Details

Journal
European Heart Journal
Published
2026-04-02
DOI
https://doi.org/10.1093/eurheartj/ehag206
Primary Topic
Cardiac pacing and defibrillation studies
Type
article
Field-Weighted Citation Impact
0.00

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Cardiac resynchronization therapy with or without atrioventricular node ablation in atrial fibrillation: the CAAN-AF trial

Martin K. Stiles, Rajiv Mahajan, Mark J. Perrin, Matthew Worthley et al.
European Heart Journal
Cardiac pacing and defibrillation studies
article

Cardiac resynchronization therapy with or without atrioventricular node ablation in atrial fibrillation: the CAAN-AF trial

Martin K. Stiles, Rajiv Mahajan, Mark J. Perrin, Matthew Worthley, John Amerena, Alexis Puvrez, Nigel Lever, Elnaz Shahmohamadi, Haris M. Haqqani, Paul Stobie, Walter P. Abhayaratna, Gijo Thomas, Rajeev K. Pathak, Adrian Esterman, Dean Boddington, P. MacIntyre, Jonathan M. Kalman, Suresh Singarayar, Anand N. Ganesan, Melissa E. Middeldorp, Stephan Willems, Peter M. Kistler, David O’Donnell, Vincent Paul, Jonathan P. Ariyaratnam, J. Alison, AM Tonkin, Daniel Ninio, David Whalley, D Chew, A Elliott, P Sanders, Matthew Webber, Gerald Kaye, Stephen J Nicholls, Raymond W Sy, Robert Park, Daniel Steven, Azlan Hussin, Stuart P Thomas
article en

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.

European Heart Journal
Australian National University (AU), Heart Rhythm Society (US), Royal Brisbane and Women's Hospital (AU), Geelong Hospital (AU), Royal Prince Alfred Hospital (AU), Royal North Shore Hospital (AU), Gold Coast Hospital (AU), Concord Repatriation General Hospital (AU), Townsville Hospital (AU), Fiona Stanley Hospital (AU), Wellington Hospital (NZ), Auckland City Hospital (NZ), Lyell McEwin Hospital (AU), Princess Alexandra Hospital (AU), The Alfred Hospital (AU), Sir Charles Gairdner Hospital (AU), Flinders Medical Centre (AU), Canberra Hospital (AU), Royal Hobart Hospital (AU), Westmead Hospital (AU), Tauranga Hospital (NZ), Women's and Children's Health Network (AU), Victoria Heart Institute Foundation (CA), Prince of Wales Hospital (AU), Asklepios Klinik St. Georg (DE), Capital and Coast District Health Board (NZ), Prince Charles Hospital (AU), Clinical Trials New Zealand (NZ), National Heart Institute (MY), Australian Centre for Heart Health (AU), University Hospital Cologne (DE), Melbourne Health (AU), Austin Health (AU), University of Waikato (NZ), Monash University (AU), The University of Adelaide (AU)
National Health and Medical Research Council
Openalex Percentile: Top 23%
Cardiac pacing and defibrillation studies
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.