skip to main content

AF Ablation in HF — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardCardiologyAF Ablation in HFRACP Adult Medicine

A 70-year-old man with persistent AF and HFrEF (LVEF 30%) is suboptimally rate-controlled on maximum beta-blocker and digoxin. HR remains 120 bpm at rest. He is too breathless for cardioversion to be attempted. Amiodarone was tried but caused thyrotoxicosis. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Ablation referral

AF with HFrEF failing medical rate control and amiodarone is an indication for catheter ablation. The CASTLE-AF trial showed catheter ablation in AF with HF significantly reduces mortality and HF hospitalisation compared to medical therapy. AV node ablation with biventricular pacing (ablate-and-pace) is considered if catheter ablation fails. Flecainide is contraindicated in structural heart disease.

Reference: CSANZ – 2024 – AF; CASTLE-AF Trial; ESC 2024