Hariharan Sugumar1, Sandeep Prabhu2, Ben Costello3, David Chieng1, Sonia Azzopardi3, Aleksandr Voskoboinik1, Ramanathan Parameswaran4, Geoffrey R Wong4, Robert Anderson5, Ahmed M Al-Kaisey4, Liang-Han Ling6, Emily Kotschet7, Andrew J Taylor3, Jonathan M Kalman5, Peter M Kistler8. 1. Department of Cardiology, The Baker Heart Research Institute, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Cardiology, University of Melbourne, Melbourne, Australia. 2. Department of Cardiology, The Baker Heart Research Institute, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia; Department of Cardiology, University of Melbourne, Melbourne, Australia. 3. Department of Cardiology, The Baker Heart Research Institute, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia. 4. Department of Cardiology, The Alfred Hospital, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Cardiology, University of Melbourne, Melbourne, Australia. 5. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Cardiology, University of Melbourne, Melbourne, Australia. 6. Department of Cardiology, The Alfred Hospital, Melbourne, Australia; Department of Cardiology, University of Melbourne, Melbourne, Australia. 7. Department of Cardiology, Monash Health, Melbourne, Australia. 8. Department of Cardiology, The Baker Heart Research Institute, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia; Department of Cardiology, University of Melbourne, Melbourne, Australia. Electronic address: peter.kistler@baker.edu.au.
Abstract
OBJECTIVES: This study sought to determine the long-term outcomes of restoring sinus rhythm with catheter ablation (CA). BACKGROUND: The CAMERA-MRI (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Heart Failure-An MRI-Guided Multicenter Randomized Controlled Trial) study demonstrated that restoration of sinus rhythm with CA significantly improved left ventricular ejection fraction (LVEF) compared with medical rate control (MRC) at 6 months in persistent atrial fibrillation and otherwise unexplained systolic heart failure. However, the long-term outcomes have not been reported. METHODS:Patients enrolled in the CAMERA-MRI study were followed for 4 years with echocardiogram and cardiac magnetic resonance. CA involved pulmonary vein isolation and posterior left atrial wall isolation in 94%. Patients crossed over to CA after 6-month study duration. Arrhythmia burden was determined with implanted cardiac monitors or cardiac devices. RESULTS:Sixty-six patients (age 62 ± 10 years, atrial fibrillation duration of 22 ± 16 months, and LVEF 33 ± 9%) were randomized 1:1 to CA versus MRC. Eighteen of 33 patients crossed over from MRC group to CA group. At 4.0 ± 0.9 years, atrial fibrillation recurred in 27 patients (57%) in the CA group with a mean burden of 10.6 ± 21.2% after 1.4 ± 0.6 procedures. There was an absolute increase in LVEF with CA of 16.4 ± 13.3% compared with 8.6 ± 7.6% in MRC (p = 0.001). In the CA group, the absence of ventricular late gadolinium enhancement was associated with a greater improvement in absolute LVEF (19 ± 13% vs. 10 ± 11% in the late gadolinium enhancement-positive group; p = 0.04) and LVEF normalization in 19 patients (58%) versus 4 patients (18%) in the late gadolinium enhancement-positive group (p = 0.008) at 4.0 ± 0.9 years follow-up. CONCLUSIONS:CA is superior to MRC in improving LVEF in the long term in patients with atrial fibrillation and systolic heart failure. The greatest recovery in systolic function was demonstrated in the absence of ventricular fibrosis on cardiac magnetic resonance.
RCT Entities:
OBJECTIVES: This study sought to determine the long-term outcomes of restoring sinus rhythm with catheter ablation (CA). BACKGROUND: The CAMERA-MRI (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Heart Failure-An MRI-Guided Multicenter Randomized Controlled Trial) study demonstrated that restoration of sinus rhythm with CA significantly improved left ventricular ejection fraction (LVEF) compared with medical rate control (MRC) at 6 months in persistent atrial fibrillation and otherwise unexplained systolic heart failure. However, the long-term outcomes have not been reported. METHODS:Patients enrolled in the CAMERA-MRI study were followed for 4 years with echocardiogram and cardiac magnetic resonance. CA involved pulmonary vein isolation and posterior left atrial wall isolation in 94%. Patients crossed over to CA after 6-month study duration. Arrhythmia burden was determined with implanted cardiac monitors or cardiac devices. RESULTS: Sixty-six patients (age 62 ± 10 years, atrial fibrillation duration of 22 ± 16 months, and LVEF 33 ± 9%) were randomized 1:1 to CA versus MRC. Eighteen of 33 patients crossed over from MRC group to CA group. At 4.0 ± 0.9 years, atrial fibrillation recurred in 27 patients (57%) in the CA group with a mean burden of 10.6 ± 21.2% after 1.4 ± 0.6 procedures. There was an absolute increase in LVEF with CA of 16.4 ± 13.3% compared with 8.6 ± 7.6% in MRC (p = 0.001). In the CA group, the absence of ventricular late gadolinium enhancement was associated with a greater improvement in absolute LVEF (19 ± 13% vs. 10 ± 11% in the late gadolinium enhancement-positive group; p = 0.04) and LVEF normalization in 19 patients (58%) versus 4 patients (18%) in the late gadolinium enhancement-positive group (p = 0.008) at 4.0 ± 0.9 years follow-up. CONCLUSIONS: CA is superior to MRC in improving LVEF in the long term in patients with atrial fibrillation and systolic heart failure. The greatest recovery in systolic function was demonstrated in the absence of ventricular fibrosis on cardiac magnetic resonance.
Authors: Michele Magnocavallo; Antonio Parlavecchio; Giampaolo Vetta; Carola Gianni; Marco Polselli; Francesco De Vuono; Luigi Pannone; Sanghamitra Mohanty; Filippo Maria Cauti; Rodolfo Caminiti; Vincenzo Miraglia; Cinzia Monaco; Gian-Battista Chierchia; Pietro Rossi; Luigi Di Biase; Stefano Bianchi; Carlo de Asmundis; Andrea Natale; Domenico Giovanni Della Rocca Journal: J Clin Med Date: 2022-09-21 Impact factor: 4.964