Brignole M, Pentimalli F, Palmisano P, et al. - Ablation + CRT (atrioventricular junction ablation and biventricular pacemaker) affords a superior treatment strategy than pharmacological therapy for decreasing mortality in patients with permanent atrial fibrillation (AF) and narrow QRS who were hospitalized for heart failure (HF), regardless of their baseline ejection fraction (EF).

• This is an international, open-label, blinded outcome trial of patients with severely symptomatic permanent AF >6 months, narrow QRS (≤110 ms) and at least one HF hospitalization in the previous year.

• They (n=133) were randomized to Ablation + CRT or to pharmacological rate control.

• Occurrence of primary endpoint (all-cause death) was evident in 7 patients (11%) in the Ablation + CRT arm and in 20 patients (29%) in the Drug arm [hazard ratio (HR) 0.26].

• At 2 years, death rates were 5% and 21%; at 4 years, 14% and 41%, in the Ablation + CRT and Drug arms respectively.

• In those with EF ≤35% or >35%, a similar benefit of Ablation + CRT of all-cause mortality was seen.

• In the Ablation + CRT arm, the secondary endpoint integrating all-cause mortality or HF hospitalization was significantly lower [18 (29%) vs 36 (51%); HR 0.40].