057 A randomised controlled trial of catheter ablation vs medical treatment of atrial fibrillation in heart failure (the CAMTAF trial)

Abstract

Introduction: We sought to compare the impact of a catheter ablation strategy (CA) to a medical rate control strategy (MED) in patients with persistent atrial fibrillation (AF) and heart failure (HF). Methods: Patients with persistent AF, symptomatic HF, and a left ventricular (LV) ejection fraction (EF) < 50%, were randomised to CA or MED. HF medication and anticoagulation were optimised prior to baseline observations. For those with recurrent AF in the CA group, a repeat procedure was performed at the end of the 3 month blanking period and follow up re-started. The primary end-pointwas the difference in LV EF between groups on echocardiography at 6 months. Echocardiographic data were anonymized and core reported by a blinded collaborating centre. Results: 54 patients were randomised, but 5 were excluded (LV normalised during optimisation of medications prior to baseline tests in 2, and 3 withdrew un-happy with their treatment allocation). Patients were 58 + 11 yrs and 96% were male. Baseline EF was 31 + 10% in the CA group and 33 + 9% in theMED group. NYHA class was 2.5 + 0.5 in both groups. Patients underwent 1.6 + 0.7 procedures. There were 2 complications: 1 stroke and 1 tamponade. In the CA group 1 patient withdrew after a procedural stroke, and in the MED group 1 patient died. All 21 remaining in the MED group, and the 24 of 26 in the CA group that had reached 6 months follow-up were included in the analysis of the primary end-point. Freedom from AF was achieved in 21/24 (88%) off antiarrhythmic drugs. LV EF in the CA group at 6 months was 39 + 10% compared to 32 + 13% in the MED group (p < 0.05). NYHA class was also significantly lower in the CA group (1.7 + 0.8 compared to 2.3 + 0.6 in the MED group; p < 0.05). Conclusions: CA is effective in restoring sinus rhythm in patients with persistent AF and HF, and improves LV function and heart failure symptoms compared to medical treatment alone.