Surrogate outcomes showed a similar benefit favoring CA .
Conclusion and Relevance Catheter ablation for AF in HFrEF is associated with improvement in patient-centered outcomes and surrogate outcomes when compared to st and ard medical therapy with or without device therapy
Background Atrial fibrillation ( AF ) among patients with heart failure with reduced ejection fraction ( HFrEF ) is associated with adverse clinical outcomes .
Our primary aim was to evaluate patient-centered outcomes and surrogate outcomes following catheter ablation ( CA ) of AF among patients with HFrEF compared to st and ard medical therapy with or without device therapy ( atrioventricular node ablation and cardiac resynchronization therapy ) .
Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial
Background — Whether catheter ablation ( CA ) is superior to amiodarone ( AMIO ) for the treatment of persistent atrial fibrillation ( AF ) in patients with heart failure is unknown . Methods and Results — This was an open-label , r and omized , parallel-group , multicenter study . Patients with persistent AF , dual-chamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator , New York Heart Association II to III , and left ventricular ejection fraction < 40 % within the past 6 months were r and omly assigned ( 1:1 ratio ) to undergo CA for AF ( group 1 , n=102 ) or receive AMIO ( group 2 , n=101 ) . Recurrence of AF was the primary end point . All-cause mortality and unplanned hospitalization were the secondary end points . Patients were followed up for a minimum of 24 months . At the end of follow-up , 71 ( 70 % ; 95 % confidence interval , 60%–78 % ) patients in group 1 were recurrence free after an average of 1.4±0.6 procedures in comparison with 34 ( 34 % ; 95 % confidence interval , 25%–44 % ) in group 2 ( log-rank P<0.001 ) . The success rate  of CA in the different centers after a single procedure ranged from 29 % to 61 % . After adjusting for covariates in the multivariable model , AMIO therapy was found to be significantly more likely to fail ( hazard ratio , 2.5 ; 95 % confidence interval , 1.5–4.3 ; P<0.001 ) than CA . Over the 2-year follow-up , the unplanned hospitalization rate was ( 32 [ 31 % ] in group 1 and 58 [ 57 % ] in group 2 ; P<0.001 ) , showing 45 % relative risk reduction ( relative risk , 0.55 ; 95 % confidence interval , 0.39–0.76 ) . A significantly lower mortality was observed in CA ( 8 [ 8 % ] versus AMIO ( 18 [ 18 % ] ; P=0.037 ) . Conclusions — This multicenter r and omized study shows that CA of AF is superior to AMIO in achieving freedom from AF at long-term follow-up and reducing unplanned hospitalization and mortality in patients with heart failure and persistent AF . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00729911
Surrogate outcomes showed a similar benefit favoring CA .
Conclusion and Relevance Catheter ablation for AF in HFrEF is associated with improvement in patient-centered outcomes and surrogate outcomes when compared to st and ard medical therapy with or without device therapy
Background Atrial fibrillation ( AF ) among patients with heart failure with reduced ejection fraction ( HFrEF ) is associated with adverse clinical outcomes .
Our primary aim was to evaluate patient-centered outcomes and surrogate outcomes following catheter ablation ( CA ) of AF among patients with HFrEF compared to st and ard medical therapy with or without device therapy ( atrioventricular node ablation and cardiac resynchronization therapy ) .