{"id":"46025","type":"article","url":"https://hartvaat.nl/2026/04/16/caan-af-av-knoopablatie-verbetert-crt-uitkomsten-bij-permanent-atriumfibrilleren/","title":"CAAN-AF: AV-knoopablatie verbetert CRT-uitkomsten bij permanent atriumfibrilleren niet","title_en":"Cardiac resynchronization therapy with or without atrioventricular node ablation in atrial fibrillation: the CAAN-AF trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehag206","source_url":"https://doi.org/10.1093/eurheartj/ehag206","authors":["Prashanthan Sanders","Jonathan P Ariyaratnam","Martin K Stiles","Alexis Puvrez","Stephen J Nicholls","Walter P Abhayaratna","Mark J Perrin","Jeff Alison","Rajeev K Pathak","Anand Ganesan","Vincent Paul","Stuart P Thomas","Gijo Thomas","Melissa E Middeldorp","Elnaz Shahmohamadi","Adrian D Elliott","Robert Park","Haris Haqqani","Dean Boddington","Peter M Kistler","Paul Martin","Raymond W Sy","Stephan Willems","Paul Stobie","Matthew Webber","Gerald Kaye","Paul MacIntyre","Bobby John","Daniel Steven","Azlan Hussin","Suresh Singarayar","David Whalley","David O'Donnell","Nigel Lever","Rajiv Mahajan","Daniel Ninio","John Amerena","Adrian Esterman","Derek P Chew","Matthew Worthley","Andrew Tonkin","Carmine G De Pasquale","Jonathan M Kalman"],"significance":7,"published":"2026-07-14","source_date":"2026-04-16","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/kleplijden/mitralisregurgitatie/"],"congress":"","summary_en":"The CAAN-AF trial tested whether atrioventricular node ablation (AVNA) added to cardiac resynchronisation therapy (CRT-D) improves outcomes in patients with heart failure with reduced ejection fraction and permanent atrial fibrillation, versus medical rate control. The trial stopped early for futility: among 143 randomized patients there was no difference in the primary endpoint (all-cause mortality plus non-fatal heart-failure events; IRR 1.16) or in secondary outcomes. In this randomized setting AVNA showed no benefit over medical rate control.","created":"2026-07-03T20:27:07Z","updated":"2026-07-04T19:27:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De CAAN-AF-trial onderzocht of atrioventriculaire knoopablatie (AVNA) bovenop cardiale resynchronisatietherapie (CRT-D) de uitkomsten verbetert bij patiënten met hartfalen met verminderde ejectiefractie en permanent atriumfibrilleren, vergeleken met medicamenteuze frequentiecontrole. De trial werd vroegtijdig gestopt wegens futiliteit: bij 143 gerandomiseerde patiënten was er geen verschil in het primaire eindpunt (totale sterfte plus niet-fatale hartfalenevents; IRR 1,16) of in de secundaire uitkomsten. AVNA toonde in deze gerandomiseerde setting dus geen meerwaarde boven medicamenteuze frequentiecontrole.","abstract_original":"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."}