Abstract 17358: Preliminary Results from AATAC: Ablation vs Amiodarone for the Treatment of Persistent and Long Standing Persistent Atrial Fibrillation in Patients With Congestive Heart Failure.
Introduction: Catheter ablation is being increasingly used for the treatment of patients with congestive heart failure and atrial fibrillation (AF). Whether catheter ablation is superior to Amiodarone for the treatment of AF in this subset of patients is unknown. The aim of this study was to randomize the two different treatments and to look at freedom from AF at follow-up.
Methods: 105 consecutive patients with symptomatic, persistent or long-standing persistent atrial fibrillation, with EF ≤ 35% and NYHA II-III were randomized into 2 groups: pts undergoing treatment of AF with Amiodarone (n=52) and patients undergoing catheter ablation of atrial fibrillation off Amiodarone (n=53). In patients undergoing ablation, pulmonary vein isolation (PVI) was guided by circular mapping. The electrical isolation of the pulmonary veins was extended to the entire posterior wall. In addition linear lesions and ablation of complex fractionated atrial electrograms (CFAEs) in the right and left atrium and in the coronary sinus were also performed. Patients of both groups had and ICD implanted to monitor recurrences and episodes of AF.
Results: Out of the 105 patients included in the study, 53 underwent ablation (group 1) and 52 were treated with Amiodarone (group 2). Both groups were comparable in their baseline and major clinical characteristics: left atrium size (47±5 mm, 48±6 mm, p=0.356), history of AF (81±72, 92±64 months, p=0.732), and left ventricular EF (29±8, 30±7, p=0.573) respectively for group 1 and 2. At 10±9 months follow-up, 40 (75%) patients in group 1 were AF recurrences free after two procedures as compared to 24 (46%) in group 2 (log-rank p = 0.003). Success rate of ablation in the different centers after a single procedure ranged from 39% to 61%.
Conclusions: These preliminary results suggest that catheter ablation of atrial fibrillation is superior to Amiodarone to achieve freedom from AF at follow up in patients with heart failure and persistent or long standing persistent AF.
- © 2010 by American Heart Association, Inc.