Cardiac resynchronization therapy and AV node ablation in heart failure with reduced ejection fraction and atrial fibrillation: Rationale and design of the CAAN-AF trial

Abstract

Background Cardiac resynchronization therapy (CRT) is an important treatment modality for patients with symptomatic heart failure (HF) with reduced ejection fraction (HFrEF) and QRS prolongation on electrocardiogram. However, patients with atrial fibrillation (AF) appear to benefit less from CRT compared to patients in sinus rhythm. Atrioventricular (AV) node ablation has been shown in observational studies to improve the efficacy of CRT in patients with AF. Objective We aimed to evaluate the effect of AV node ablation on CRT efficacy in patients with permanent AF. Methods Participants with permanent AF and a reduced left ventricular ejection fraction (≤35%) who receive a CRT-defibrillator a..