Compares heart-rate medicines with pacemaker and ablation for atrial fibrillation
Tests a pacemaker with heart-area ablation against medicines for atrial fibrillation with heart failure.
Plain-language title generated from the registry record
Registry title: RAFT - Pace &Ablate
Key facts
- Where
- Halifax, Hamilton, Kitchener, London, Montreal, Newmarket, Ottawa, Québec, Sherbrooke, Toronto, and Victoria, CanadaSee the 12 sites
AI summary: who the study is looking for
From the trial's eligibility criteria. Machine-read from the registry text on this page, so it can be wrong. The registry text below and the trial team decide who can take part.
The trial is looking for adults with long-lasting atrial fibrillation and heart failure symptoms who already take heart failure medicines. It compares pace and ablate with medicines alone.
- Age
- 18 years or older
- Sex
- All sexes can join.
- Disease stage
- Permanent or persistent atrial fibrillation (currently in AF) with NYHA Class II-IVa heart failure symptoms.
- Earlier treatment
- At least 3 months of guideline-driven medical therapy for heart failure. NT-proBNP of at least 600 ng/L if under 75 years old. NT-proBNP of at least 900 ng/L if 75 or older, or at least 600 ng/L with a heart failure hospital stay within 1 year.
- Biomarker or test result
- NT-proBNP of at least 600 ng/L (under 75) or at least 900 ng/L (75 or older); 600 ng/L with a heart failure hospitalization within 1 year.
Main reasons for not taking part
- An existing CRT/BiVP device, or a guideline indication for CRT
- More than 20% pacing with an existing pacemaker
- Pregnancy
- Heart attack or acute coronary syndrome under 4 weeks ago, or coronary revascularization under 3 months ago
- Severe mobility limitations, or life expectancy of 1 year or less from a non-heart cause
Read by machine on 9 November 2026.
Where in Canada
- Nova Scotia Health AuthorityHalifax, CanadaTaking people
- Hamilton Health Sciences CorporationHamilton, CanadaTaking people
- Waterloo Wellington Cardiovascular Research InstituteKitchener, CanadaTaking people
- London Health Sciences Centre, University HospitalLondon, CanadaTaking people
- Centre Hospitalier de l'Universite de Montreal (CHUM)Montreal, CanadaTaking people
- Montreal Heart InstituteMontreal, CanadaTaking people
- Southlake Regional Health CentreNewmarket, CanadaTaking people
- Ottawa Heart Institute Research CorporationOttawa, CanadaTaking people
- Institut universitaire de cardiologie et de pneumologie Québec - Université Laval (IUCPQ-ULaval)Québec, CanadaTaking people
- Hôpital FleurimontSherbrooke, CanadaTaking people
- Sunnybrook Health Sciences CentreToronto, CanadaTaking people
- Victoria Cardiac Arrhythmia TrialsVictoria, CanadaTaking people
Questions to ask the study team
- How often do I need to come in, and for how long each time?
- Are travel costs paid?
- Can I keep my own doctor?
- What happens if I want to stop?
Trial details
- Who runs it
- Habib Khan
- Trial code
- NCT06299514
- Record updated
- 1 July 2026
- Original description
Atrial fibrillation (AF) is an irregular heartbeat that can cause symptoms of skipped beats, shortness of breath, stroke, or in some cases fluid in the lungs or legs. Treating AF is mostly to do with slowing the heart rate down so that the heart can get a chance to regain some energy. In some cases, slowing the heart rate is not easy to achieve as some patients find it difficult to tolerate medications and suffer side effects from these treatments. In these instances, there might be a possibility to permanently control the heart rate by implanting a pacemaker in the heart and intentionally damaging a regulatory region of the heart called the atrioventricular (AV) node. Damaging the AV node by a procedure called ablation results in the AF not being able to influence the bottom chambers (the ventricles) resulting in a slow rhythm. Therefore, if a pacemaker is implanted then the heart rate can be completely regulated by the pacemaker.Read full original descriptionShow less
Resynchronization for Ambulatory Heart Failure Trial in Patients With Chronic Atrial Fibrillation - Pharmacological Rate Control vs. Pace and Ablate With Conduction System Pacing
Atrial fibrillation (AF) is an irregular heartbeat that can cause symptoms of skipped beats, shortness of breath, stroke, or in some cases fluid in the lungs or legs. Treating AF is mostly to do with slowing the heart rate down so that the heart can get a chance to regain some energy. In some cases, slowing the heart rate is not easy to achieve as some patients find it difficult to tolerate medications and suffer side effects from these treatments. In these instances, there might be a possibility to permanently control the heart rate by implanting a pacemaker in the heart and intentionally damaging a regulatory region of the heart called the atrioventricular (AV) node. Damaging the AV node by a procedure called ablation results in the AF not being able to influence the bottom chambers (the ventricles) resulting in a slow rhythm. Therefore, if a pacemaker is implanted then the heart rate can be completely regulated by the pacemaker.
A complex pacemaker that stimulates both the right and left ventricles simultaneously (BiVP) has been used for the last decade prior to AV node ablation. More recently, a technique has been designed to reduce the number of leads in the heart, reduce procedure time and have a similar effect on the heart called Conduction System Pacing (CSP). There is not enough existing evidence to show that a pace and ablate strategy is superior to optimal medical therapy. We intend to compare the efficacy of CSP with AV node ablation to optimal medical therapy for treating AF.
Inclusion: Patients with permanent AF/persistent AF (in AF); Patients with NYHA Class II -IVa HF symptoms; Guideline driven medical therapy (GDMT) for HF for at least 3 months:; for those < 75 years of age with an NT-proBNP of ≥ 600 ng/L; for those ≥ 75 years of age with an NT-proBNP ≥ 900 ng/L, or ≥ 600 ng/L if the patient has had a HF hospitalization within 1 year.
Exclusion: Patients with a life expectancy of ≤ 1 year from non-cardiac cause or anticipating a transplant within 1 year; Acute coronary syndrome <4 weeks or coronary revascularization <3months; Uncorrected primary valvular disease or prosthetic tricuspid valve; Severe pulmonary diseases requiring oxygenation; Patients with a known history of WHO Class I pulmonary hypertension (PH) which includes PH associated with CVD, collagen vascular disease, congenital shunts, cirrhosis and portal hypertension, HIV, hemoglobinopathies, schistosomiasis or drug-associated PH as well as those with high suspicion of irreversible pulmonary hypertension; Severe mobility limitations (ex. wheelchair bound and severe neurological conditions that limit mobility); In hospital patients needing intensive care or intravenous inotropic agent in the last 4 days; Unable or unwilling to provide informed consent; Restrictive, hypertrophic, or irreversible form of cardiomyopathy; Patients enrolled in competitive clinical trials that will affect the objectives of this study; Existing CRT/BiVP; Patients who are pregnant; Guideline indication for CRT; More than 20% pacing with an existing pacemaker.