“…we don’t need to pursue more complex approaches, but rather focus on simplifying structures and making sure we target early therapies.”
The role of rhythm control in patients with atrial fibrillation and heart failure has been one of the most closely debated topics in recent years. At the ESC Congress 2025, the POLAR-HF trial (ClinicalTrials.gov identifier: NCT04461691) added important new evidence, suggesting that simple pulmonary vein isolation (PVI)-only strategies are both effective and safe in patients with heart failure with reduced ejection fraction (HFrEF).1,2
Dr Andreas Boehmer (St Josefs Hospital Wiesbaden, Wiesbaden, Germany), lead investigator of the study, shared his perspective on how these findings may change practice. In this interview, he explains why less complex ablation approaches can be sufficient in patients with HFrEF, how the timing of intervention influences outcomes, and what POLAR-HF means in the broader context of trials like EAST-AFNET 4 for shaping future atrial fibrillation and heart failure guidelines.3
Q. Polar HF has been closely watched for its insights into rhythm control strategies. What is the single most practice changing finding from the trial that you think clinicians should take home?
I think we’ve seen that simple approaches such as pulmonary vein isolation (PVI)-only approaches also work in patients with heart failure with reduced ejection fraction (HFrEF), not only in patients without HFrEF at the same time, not compromising safety.
Q. Were there any subgroup results that could influence personalized treatment approaches?
Well, we did not observe a difference between rhythm outcomes in patients with atrial fibrillation (AF)- mediated cardiomyopathy compared with patients with ischaemic or dilated cardiomyopathy. So PVI-only approach or simplified approach appears to work fine for both entities of HFrEF.
Q. How do you see the POLAR-HF data fitting alongside EAST-AFNET 4 and other recent rhythm control studies in shaping the next iteration of atrial fibrillation or heart failure management guidelines?
Obviously, we’ve learned within the last 5 years that early rhythm control does matter and time from diagnosis to ablation in the POLAR-HF study was 4 months with which may, at least at part, explain the positive results in the HFrEF cohort. So I think we don’t need to pursue more complex approaches, but rather focus on simplifying structures and making sure we target early therapies.
References
- Boehmer A. Pulmonary vein isolation only for atrial fibrillation with heart failure. Presented at ESC Congress 2025 Madrid, Spain, 30 August 2025. Available at: https://esc365.escardio.org?v=S15282-young-investigator-award-session-in-arrhythmias-pacing-and-electrophysiology (accessed 11 September 2025).
- ClinicalTrials.gov. Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation With Heart Failure (POLAR-HF). ClinicalTrials.gov identifier: NCT04461691. Available at: https://clinicaltrials.gov/study/NCT04461691 (accessed 11 September 2025).
- ClinicalTrials.gov. Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST). ClinicalTrials.gov identifier: NCT01288352. Available at: https://clinicaltrials.gov/study/NCT01288352Â (accessed 11 September 2025).
Disclosure: TBC.
Cite: #ESC2025: Andreas Boehmer on POLAR-HF and pulmonary vein isolation only for atrial fibrillation with heart failure. touchCARDIO. September 15, 2025.
Interviewer: Caroline Markham, Head of Strategic Partnerships
Editor: Heather Hall, Managing Editor
This content has been developed independently by Touch Medical Media for touchCARDIO. It is not affiliated with the European Society of Cardiology (ESC). Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
Browse all ESC 2025 content here.
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