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Two Pacing Methods After AV Node Ablation in Heart Failure With Atrial Fibrillation

Compares two heart pacing methods in adults with heart failure and atrial fibrillation.

Key facts

Who runs it
University Medical Center Groningen
Where
Grenoble, Marseille, Paris, Rouen, and Toulouse, FranceSee the 5 sitesAlso in 3 other countries, 18 sites
Trial code
Registry title
AV Nodal Ablation With Conduction System Pacing Versus Cardiac Resynchronization for Symptomatic Heart Failure Patients With Atrial Fibrillation
Status
Not yet recruiting
People taking part
292 people, planned
Started
Jul 2026
Expected to end
Jun 2030
Type of study
Interventional, 2 groupsOne group gets an existing treatment, for comparison.
Treatments tested
  • Conduction System Pacing
  • Cardiac resynchronization therapy
Record updated
22 May 2026

Who can take part

AI summary

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 heart failure and atrial fibrillation that cannot be treated by restoring a normal rhythm. All will have an AV node ablation and then get one of two types of pacemaker.

Age
18 years or older
Sex
All sexes can join
Disease stage
Stable heart failure of any left ventricular ejection fraction, with atrial fibrillation not treatable by rhythm control. At least one ECG showing atrial fibrillation in the year before joining. At least one hospital or urgent heart failure visit in the 2 years before joining.
Earlier treatment
Must be on the highest heart failure medicine doses they can tolerate, following guidelines. Must not already have a pacing device used for 40% or more of heartbeats.

Main reasons for not taking part

  • NYHA functional class IV heart failure
  • Severe other illness not related to the heart
  • Needs any heart surgery
  • Heart attack, unstable angina, stent procedure, stroke or TIA, serious bleeding or pericarditis/effusion in the last 3 months
  • Pregnant or breastfeeding

The registry criteria, word for word

Show all 11 criteriaShow less

Who can take part

  • Age 18 years or above
  • Patient is diagnosed with AF and deemed not amenable to rhythm control. This diagnosis of AF will be demonstrated by at least one Electrocardiograph (ECG) showing AF that was performed within one year prior to enrollment
  • Has history of stable heart failure (regardless left ventricular ejection fraction) and has a history of at least one HF related hospitalization or emergency room/urgent care visit within 2 years prior to enrollment, despite being on maximally tolerable guideline directed medical therapy
  • Willing and capable to provide informed consent

Who cannot take part

  • Severe concomitant non-cardiac disease
  • Previously implanted pacing devices (pacemaker/ICD/CRT) with ≥40% pacing burden
  • Any of the following within the 3 months prior to enrollment:; Myocardial infarction; Unstable angina; Percutaneous coronary intervention; Stroke or TIA; Significant bleeding; Pericarditis/effusions
  • Coronary artery bypass surgery/atriotomy within 6 months prior to enrolment
  • Patient who require any cardiac surgical intervention
  • NYHA functional class IV
  • Women who are pregnant or breastfeeding

Where in France

Also in 3 other countries, 18 sites

  • CHU de GrenobleGrenoble, FranceContact: Pascal Defaye, MDNo longer taking part
  • CHU La TimoneMarseille, FranceContact: Jean-claude Deharo, MDNo longer taking part
  • Hôpital Européen Georges PompidouParis, FranceContact: Eloi Marijon, MDNo longer taking part
  • CHU de RouenRouen, FranceContact: Frederic Anselme, MDNo longer taking part
  • Clinique Pasteur - ToulouseToulouse, FranceContact: Serge Boveda, MDNo longer taking part

About the trial

What the trial wants to find out

The goal of this clinical trial is to learn if conduction system pacing works as well as cardiac resynchronization therapy (CRT) post atrioventricular (AV) node ablation in adult patients with symptomatic heart failure and atrial fibrillation that is not suitable for rhythm control.

Read full original descriptionShow less

The main question it aims to answer is:

Is AV node ablation with conduction system pacing noninferior to AV node ablation with CRT for the hierarchical composite outcome of all-cause mortality, heart failure hospitalization or urgent heart failure visit, and meaningful improvement in heart failure-related quality of life?

Participants will undergo:

* An AV node ablation and be randomly assigned to receive either a conduction system pacing or a CRT. * Attend follow-up visits (in clinic or by telephone) at baseline, intervention day, 3-month, 12-month, 24-month, and 36-month after the procedure. * Complete questionnaires about heart failure symptoms and quality of life at baseline, 12 months, and yearly. * Have an echocardiogram, an electrocardiogram, and blood tests at baseline and 1 year * At selected centers: they will be asked to wear a bracelet that measures arterial stiffness for 30 minutes and provide a urine sample at baseline and 1 year.

The 2 groups in the trial

  • CSP Group (Intervention Group)Other group

    AV node ablation plus Conduction System Pacing implantation. CSP is established pacing strategy evaluated in comparison with CRT.

    Treatment: Conduction System Pacing

  • CRT Group (Control Group)Existing treatment, for comparison

    AV node ablation plus cardiac resynchronization therapy implantation. CRT is established standard pacing strategy.

    Treatment: Cardiac resynchronization therapy

Questions to ask the study team

  1. How often do I need to come in, and for how long each time?
  2. Are travel costs paid?
  3. Can I keep my own doctor?
  4. What happens if I want to stop?

Contact the study team: see the registry record → Contacts and Locations

Print a page for my doctor

Data and sources

Registry record
Listed on ClinicalTrials.gov.
Official title
AV Nodal Ablation With Conduction System Pacing Versus Cardiac Resynchronization for Symptomatic Heart Failure Patients With Atrial Fibrillation: The APAF-CSP All-cause Mortality and Quality of Life Trial
Plain-language title
Two Pacing Methods After AV Node Ablation in Heart Failure With Atrial FibrillationGenerated from the registry record. The registry title is the official one.
AI summary
From the trial's eligibility criteria. Read by machine on 13 November 2026.
Record updated
22 May 2026