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AF Ablation Recommendation in HFrEF — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyAF Ablation Recommendation in HFrEFEECC

A 65-year-old man with HFrEF (LVEF 30%) and persistent AF is considered for AF catheter ablation. The 2024 ESC AF Guidelines now recommend catheter ablation in AF with HFrEF as what class of recommendation?

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Correct answer: C — Class I — catheter ablation is recommended to reverse LV dysfunction when tachycardia-induced cardiomyopathy is highly probable, and Class IIa to reduce HF progression and mortality in selected HFrEF patients with AF

The 2024 ESC AF Guidelines upgraded the recommendation for catheter ablation in AF with HFrEF based on CASTLE-AF, RAFT-AF, and AMICA trials: (1) Class I: when tachycardia-induced cardiomyopathy is highly probable (reversing the causative arrhythmia is the most effective treatment); (2) Class IIa: to improve LVEF and reduce HF hospitalisations and mortality in selected patients with HFrEF and AF not responding to medical rate/rhythm control. This represents a significant upgrade from previous guidelines and reflects growing evidence that AF ablation in HFrEF patients can improve LVEF, symptoms, and hard outcomes. Patient selection (considering AF duration, LA size, comorbidities) remains important for optimising ablation success.

Reference: ESC (2024): Guidelines for the Management of Atrial Fibrillation