Trial reportEuropean heart journal2026
Withdrawal of heart failure therapy after atrial fibrillation rhythm control with ejection fraction normalization: the WITHDRAW-AF trial.
Trial report in European heart journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed.
- Heart Failure Medication Withdrawal in Patients With Improved Cardiac Function After Atrial Fibrillation Ablation: The DEFINITION-AF Pilot Randomized Clinical Trial.JAMA network open · 2026Trial
- Phenotype-Guided Management of Atrial Fibrillation in Heart Failure: From Rate Control to Catheter Ablation.Journal of clinical medicine · 2026Review
- Graded Associations Between Left Ventricular Ejection Fraction Improvement and Cardiorenal Outcomes in Heart Failure With Improved Ejection Fraction.Journal of the American Heart Association · 2026Article
- Atrial Fibrillation Risk Management and Emerging Therapies.Journal of clinical medicine · 2026Review
- Evaluation and management of recent onset cardiomyopathy in the current era of heart failure therapeutics: a clinical consensus statement of the Heart Failure Association of the ESC.ESC heart failure · 2026Review
- The prognostic impact of beta blockers in ischemic heart failure: time for a paradigm shift?Heart failure reviews · 2026Review
- Review
- Withdrawing heart failure therapy after AF rhythm control: promise, caution, and perspective.European heart journal. Cardiovascular pharmacotherapy · 2026Article
- Clinical Implications of Left Atrial and Ventricular Reverse Remodeling After Atrial Fibrillation Ablation in Patients With Systolic Dysfunction.Journal of the American Heart Association · 2026Article
- Pulmonary vein isolation as the fifth column of heart failure therapy: a case report.European heart journal. Case reports · 2025Article
- Reverse Remodelling, Myocardial Recovery and Remission in Heart Failure with Reduced Ejection Fraction: Clinical Implications and Management Strategies.Cardiac failure review · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
26 authors.
Funding
Abstract
BACKGROUND AND
aimsAtrial fibrillation-mediated cardiomyopathy (AFCM) represents an important reversible cause of left ventricular systolic dysfunction. Current clinical practice is indefinite heart failure (HF) pharmacotherapy despite left ventricular ejection fraction (LVEF) normalization. However, whether this is necessary to maintain normal LVEF, in addition to rhythm control, is uncertain.
methodsThis multi-centre, randomized trial conducted between 2021 and 2024 examined the impact of staged withdrawal of HF therapy following AF rhythm control and LVEF normalization in AFCM. Participants were randomized (1:1) to early withdrawal (Group A) or continued therapy for 6 months followed by delayed withdrawal (Group B), in a crossover design. The primary endpoint was the randomized comparison of cardiac magnetic resonance (CMR) LVEF maintenance ≥50% at 6 months, during which time Group A had withdrawn therapy and Group B remained on treatment. Secondary outcomes included cardiac remodelling, functional status, biomarkers, quality of life, and arrhythmia recurrence on vs off HF therapy. The total follow-up duration was 12 months.
resultsBetween July 2021 and May 2024, 60 patients were enrolled (age 60 [55-65] years, previous persistent AF <1 year and maintaining sinus rhythm for minimum 6 months following AF rhythm control [catheter ablation in 97%]). All participants completed treatment withdrawal and 12-month follow-up. In the initial randomized comparison, LVEF was maintained ≥50% at 6 months in 90% of participants undergoing HF therapy withdrawal (Group A), compared with 100% who continued medical therapy (Group B) (odds ratio [OR] 1.18, 95% confidence interval [CI] 0.27-2.82, P = .47). CMR LVEF was similar between randomization groups at the end of the randomization phase (Group A: LVEF 58% [95% CI 54-60] vs Group B: LVEF 59% [95% CI 55-64], P = .236) and across study time points (mixed effects P = .37). Transthoracic echocardiography characteristics, N-terminal pro-B-type natriuretic peptide, functional status, quality of life and AF burden were similar on vs off HF therapy in the overall population.
conclusionsWithdrawal of HF therapy following AF rhythm control for prior AFCM and recovered LVEF was not associated with a decline in LVEF for most patients in the following 6 months.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.