Ablation Versus 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 atrial fibrillation (AF) in patients with heart failure is unknown. Methods and Results This was an open label, randomized, parallel group, multicenter study. Patients with persistent AF, dual chamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator, New York Heart Association II to III, and left ventricular ejection fraction <40% within the past 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 end points. Patients were followed up for a minimum of 24 months. At the end of follow up, 71 (70% 95% confidence interval, 60% 78% patients in group 1 were recurrence free after an average of 1.4+ 0.6 procedures in comparison with 34 (34% 95% confidence interval, 25% 44% in group 2 (log rank P<0.001) The success rate of CA in the different centers after a single procedure ranged from 29% to 61% After adjusting for covariates in the multivariable model, AMIO therapy was found to be significantly more likely to fail (hazard ratio, 2.5; 95% confidence interval, 1.5 4.3; P<0.001) than CA. Over the 2 year follow up, the unplanned hospitalization rate was (32 [31% in group 1 and 58 [57% in group 2; P<0.001) showing 45% relative risk reduction (relative risk, 0.55; 95% confidence interval, 0.39 0.76) A significantly lower mortality was observed in CA (8 [8% versus 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 URL: http:/www.clinicaltrials.gov. Unique identifier: NCT00729911.
Circulation