Abstract 14766: Pulmonary Vein Isolation Alone is Not Superior to Amiodarone for the Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Randomized Trial
Introduction: The best treatment option for the management of patients (pts) with heart failure (HF) and persistent AF is unknown. The AATAC trial showed that catheter ablation (CA) is superior to Amiodarone in achieving freedom from AF at follow up. In this analysis we present the outcome sorted by type of AF procedure.
Methods: AATAC was a randomized multicenter study. Pts with persistent AF, dual chamber ICD or CRTD, NYHA II-III and LV EF <40% within the last 6 months were randomly assigned (1:1 ratio) to undergo CA for AF (group 1=102 pts) or receive AMIO, (group 2=101 pts). Recurrence of AF was the primary end point. Based on operator’s choice patients could undergo pulmonary vein isolation alone (PVI) or PVI plus posterior wall plus non PV trigger ablation (PVI+PW+NPV) as detected by high dosage of isoproterenol.
Results: PVI was performed in 22 patients undergoing ablation, while PVI+PW+NPV ablation was performed in 80 patients. Baseline characteristics were not different between the groups. At 26±8 months follow-up, the success rates in PVI, PVI+PW+NPV, and AMIO groups were 8 [36.4%] and 63 [78.8%] and 34 (34.0%) respectively, p<0.001 (figure). Patients receiving PVI+PW+NPV ablation, showed significantly higher success than those with PVI alone or amiodarone (p <0.001). The outcome in the PVI alone group was not different from AMIO group (p= 0.67). No patient was lost to follow-up during the study period. At the time of analysis, all recurrence-free patients had completed ≥6 month follow-up.
Conclusion: This randomized study shows that PVI alone has a low success rate similar to Amiodarone when compared to PVI plus posterior wall plus non pv trigger in patients with heart failure and persistent AF.
Author Disclosures: L. Di Biase: Speakers Bureau; Modest; Biotronik, EpiEP, AtriCure, Inc.. Consultant/Advisory Board; Modest; Hansen Medical, St. Jude Medical. P. Mohanty: None. S. Mohanty: None. P. Santangeli: None. C. Trivedi: None. D. Lakkireddy: None. M. Reddy: None. P. Jais: None. S. Themistoclakis: None. A. Dello Russo: None. M. Casella: None. G. Pelargonio: None. M. Narducci: None. R. Schweikert: None. P. Neuzil: None. J. Sanchez: None. R. Horton: None. S. Beheiry: None. R. Hongo: None. S. Hao: None. A. Rossillo: None. G. Forleo: None. C. Tondo: None. J. Burkhardt: None. M. Haïssaguerre: None. A. Natale: Speakers Bureau; Modest; Boston Scientific Corp, Biotronik, Medtronic, Inc.. Consultant/Advisory Board; Modest; Janssen Pharmaceuticals, St. Jude Medical, Biosense Webster Inc..
- © 2015 by American Heart Association, Inc.