Ablation vs. 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 AF in patients with HF is unknown.
Methods and Results—This was an open-label, randomized, parallel-group, multicenter study. Patients 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, 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 endpoints. Patients were followed-up for a minimal of 24 months. At the end of follow-up, 71(70% [95% CI 60% - 78%]) patients in group 1 were recurrence-free after average 1.4±0.6 procedures as compared to 34 (34% [95% CI 25% - 44%]) in group 2 (log-rank p <0.001). Success rate of CA in the different centers after a single procedure ranged from 29% to 61%. After adjusting for covariates in multivariable model, patients on AMIO therapy were found to be significantly more likely to fail (HR 2.5 [95% CI 1.5 to 4.3], p <0.001) compared to CA. Over the 2 year follow-up, unplanned hospitalization rate was (32 [31%] in group 1 and 58 [57%] in group 2, p <0.001), showing 45% relative risk (RR) reduction (RR 0.55, 95% CI 0.39-0.76). A significant lower mortality was observed in CA (8 [8%] vs 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 Information—clinicaltrials.gov. Identifier: NCT00729911.
- Received September 23, 2015.
- Revision received February 21, 2016.
- Accepted February 25, 2016.