A Randomized Trial to Assess Catheter Ablation Versus Rate Control in the Management of Persistent Atrial Fibrillation in Heart Failure

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• 作者：David G. Jones ; MD^? ; ^&dagger ; ; Shouvik K. Haldar ; MBBS^? ; ^&dagger ; ; Wajid Hussain ; MB ; ChB^? ; ^&dagger ; ; Rakesh Sharma ; PhD^? ; ^&dagger ; ; Darrel P. Francis ; MD^&dagger ; ; Shelley L. Rahman-Haley ; MD^? ; Theresa A. McDonagh ; MD^? ; ^&dagger ; ; S. Richard Underwood ; MD^? ; ^&dagger ; ; Vias Markides ; MD^? ; ^&dagger ; ; Tom Wong ; MD^? ; ^&dagger ; ; ^{tom.wong@imperial.ac.uk}
• 关键词：atrial fibrillation ; catheter ablation ; heart failure ; rate-control
• 刊名：Journal of the American College of Cardiology
• 出版年：2013
• 出版时间：7 May, 2013
• 年：2013
• 卷：61
• 期：18
• 页码：1894-1903
• 全文大小：1262 K

文摘

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Objectives

This study sought to compare catheter ablation with rate control for persistent atrial fibrillation (AF) in heart failure (HF).

Background

The optimal therapy for AF in HF is unclear. Drug-based rhythm control has not proved clinically beneficial. Catheter ablation improves cardiac function in patients with HF, but impact on physiological performance has not been formally evaluated in a randomized trial.

Methods

In a randomized, open-label, blinded-endpoint clinical trial, adults with symptomatic HF, radionuclide left ventricular ejection fraction (EF) ¡Ü35 % , and persistent AF were assigned to undergo catheter ablation or rate control. Primary outcome was 12-month change in peak oxygen consumption. Secondary endpoints were quality of life, B-type natriuretic peptide, 6-min walk distance, and EF. Results were analyzed by intention-to-treat.

Results

Fifty-two patients (age 63 ¡À 9 years, EF 24 ¡À 8 % ) were randomized, 26 each to ablation and rate control. At 12 months, 88 % of ablation patients maintained sinus rhythm (single-procedure success 68 % ). Under rate control, rate criteria were achieved in 96 % . The primary endpoint, peak oxygen consumption, significantly increased in the ablation arm compared with rate control (difference +3.07 ml/kg/min, 95 % confidence interval: 0.56 to 5.59, p = 0.018). The change was not evident at 3 months (+0.79 ml/kg/min, 95 % confidence interval: ?1.01 to 2.60, p = 0.38). Ablation improved Minnesota score (p = 0.019) and B-type natriuretic peptide (p = 0.045) and showed nonsignificant trends toward improved 6-min walk distance (p = 0.095) and EF (p = 0.055).

Conclusions

This first randomized trial of ablation versus rate control to focus on objective exercise performance in AF and HF shows significant benefit from ablation, a strategy that also improves symptoms and neurohormonal status. The effects develop over 12 months, consistent with progressive amelioration of the HF syndrome. (A Randomised Trial to Assess Catheter Ablation Versus Rate Control in the Management of Persistent Atrial Fibrillation in Chronic Heart Failure; )