Pacemaker-implantation and atrioventricular-node ablation vs pulmonary vein isolation for elderly patients with persistent atrial fibrillation: the ABLATE versus PACE trial

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ID: 327123
2026
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Abstract
BACKGROUND AND AIMS: Population aging is increasing atrial fibrillation (AF) prevalence. In elderly patients with persistent AF, pulmonary-vein isolation (PVI) has limited success, but is widely used. Pacemaker-implantation with atrioventricular-node ablation (PM+AVNA) provides effective symptom control, but the relative effects of PM+AVNA versus PVI on hospitalisations and other outcomes in the elderly remain unknown. METHODS: This investigator-initiated, multicentre, open-label trial randomised patients aged≥75 years with symptomatic persistent AF and normal left-ventricular ejection fraction to PM+AVNA or PVI treatment-strategies. The primary endpoint was a composite of hospitalisation for atrial arrhythmia or heart failure, outpatient electrical cardioversion or upgrade to cardiac resynchronisation therapy for left-ventricular dysfunction. Secondary endpoints included all-cause death, stroke, treatment-related complications and quality of life. RESULTS: Twelve centres in Germany and Austria randomised 196 patients (median age 82 years). At 12 months, a first primary endpoint event occurred in 24 of 98 patients (24%) assigned to PM+AVNA and 45 of 98 patients (46%) assigned to PVI (hazard ratio 0.45, 95% confidence interval 0.27 to 0.74; P=0.002). A total of 29 and 84 primary endpoint events occurred respectively, consisting principally of AF-hospitalisations and cardioversions in the PVI group (54 and 19 respectively, vs 3 and 1 in PM+AVNA group) and of heart failure-hospitalisations in the PM+AVNA Group (23, vs 11 in PVI group). The incidence of cardiovascular complications and mortality, as well as qualityof-life, were not statistically different. CONCLUSIONS: In elderly patients with persistent AF, PM+AVNA was associated with fewer primary endpoint events than PVI over a 12-month follow-up period.
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Authors Andreas A. Boehmer, Lars Eckardt, Moritz Rothe, Bernhard M. Kaess, Florian Doldi, Fatih Guener, Harilaos Bogossian, Konstantinos Iliodromitis, D Bastian, V Buia, Malte Kuniss, Wolfgang Dichtl, Reza Wakili, Stephan Willems, Burghard Schumacher, Shibu Mathew, Hüseyin İnce, Stephanie Fichtner, David M. Leistner, Christian Meyer, Andreas Rillig, Andreas Metzner, Christian Ruckes, Jan G.P. Tijssen, Harry J.g.m. Crijns, Stanley Nattel, Joachim R. Ehrlich
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Journal european heart journal
Year 2026
DOI
10.1093/eurheartj/ehag742
URL
https://academic.oup.com/eurheartj/advance-article-pdf/doi/10.1093/eurheartj/ehag742/70834049/ehag742.pdf
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