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Circulation. 2016 Apr 26;133(17):1637-44. doi: 10.1161/CIRCULATIONAHA.115.019406. Epub 2016 Mar 30.

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.

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1
From Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J., M.H.); Ospedale dell'Angelo, Mestre Venice, Italy (S.T., A.R.); Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., C.T.); University of Sacred Heart, Rome, Italy (G.P., M.L.N.); Akron General Hospital, OH (R.S.); Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (P.N.); California Pacific Medical Center, San Francisco (S.B., R.H., S.H., A.N.); University of Tor Vergata, Rome, Italy (G.F.); Division of Cardiology, Stanford University, Palo Alto, CA (A.N.); Case Western Reserve University, Cleveland, OH (A.N.); Scripps Clinic, San Diego, CA (A.N.); and Dell Medical School, Austin, TX (A.N.).
2
From Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J., M.H.); Ospedale dell'Angelo, Mestre Venice, Italy (S.T., A.R.); Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., C.T.); University of Sacred Heart, Rome, Italy (G.P., M.L.N.); Akron General Hospital, OH (R.S.); Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (P.N.); California Pacific Medical Center, San Francisco (S.B., R.H., S.H., A.N.); University of Tor Vergata, Rome, Italy (G.F.); Division of Cardiology, Stanford University, Palo Alto, CA (A.N.); Case Western Reserve University, Cleveland, OH (A.N.); Scripps Clinic, San Diego, CA (A.N.); and Dell Medical School, Austin, TX (A.N.). dr.natale@gmail.com.

Abstract

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, randomized, 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 randomly 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 randomized 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.clinicaltrials.gov. Unique identifier: NCT00729911.

KEYWORDS:

amiodarone; atrial fibrillation; catheter ablation; heart failure

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