A Randomized Controlled Trial of Catheter Ablation Versus Medical Treatment of Atrial Fibrillation in Heart Failure (The CAMTAF Trial)

作者：Hunter, Ross J.; Berriman, Thomas J.; Diab, Ihab; Kamdar, Ravindu; Richmond, Laura; Baker, Victoria; Goromonzi, Farai; Sawhney, Vinit; Duncan, Edward; Page, Stephen P.; Ullah, Waqas; Unsworth, Beth; Mayet, Jamil; Dhinoja, Mehul; Earley, Mark J.; Sporton, Simon; Schilling, Richard J.^*

来源：Circulation-Arrhythmia and Electrophysiology, 2014, 7(1): 31-38.

DOI：10.1161/CIRCEP.113.000806

• VENTRICULAR SYSTOLIC DYSFUNCTION
• CARDIAC RESYNCHRONIZATION THERAPY
• ANTIARRHYTHMIC-DRUG THERAPY
• PULMONARY-VEIN ISOLATION
• FOLLOW-UP
• SINUS RHYTHM
• RADIOFREQUENCY ABLATION
• PROGNOSTIC-SIGNIFICANCE
• EUROPEAN-SOCIETY
• TASK-FORCE

<jats:sec>
<jats:title>Background—</jats:title>
<jats:p>Restoring sinus rhythm in patients with heart failure (HF) and atrial fibrillation (AF) may improve left ventricular (LV) function and HF symptoms. We sought to compare the effect of a catheter ablation strategy with that of a medical rate control strategy in patients with persistent AF and HF.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods and Results—</jats:title>
<jats:p>
Patients with persistent AF, symptomatic HF, and LV ejection fraction &lt;50% were randomized to catheter ablation or medical rate control. The primary end-point was the difference between groups in LV ejection fraction at 6 months. Baseline LV ejection fraction was 32±8% in the ablation group and 34±12% in the medical group. Twenty-six patients underwent catheter ablation, and 24 patients were rate controlled. Freedom from AF was achieved in 21/26 (81%) at 6 months off antiarrhythmic drugs. LV ejection fraction at 6 months in the ablation group was 40±12% compared with 31±13% in the rate control group (
<jats:italic>P</jats:italic>
=0.015). Ablation was associated with better peak oxygen consumption (22±6 versus 18±6 mL/kg per minute;
<jats:italic>P</jats:italic>
=0.014) and Minnesota living with HF questionnaire score (24±22 versus 47±22;
<jats:italic>P</jats:italic>
=0.001) compared with rate control.
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions—</jats:title>
<jats:p>Catheter ablation is effective in restoring sinus rhythm in selected patients with persistent AF and HF, and can improve LV function, functional capacity, and HF symptoms compared with rate control.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Clinical Trial Registration—</jats:title>
<jats:p>
URL:
<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">http://www.clinicaltrials.gov</jats:ext-link>
. Unique identifier: NCT01411371
</jats:p>
</jats:sec>

• 出版日期2014-2