Mr Jones and Mrs Smith have different types of heart disease but both also have atrial fibrillation (AF) as well that creates significant additional burden. In each case a decision must be made about an ablation procedure. At the 2015 American College of Cardiology annual meeting in March, research was presented that provides evidence for the correct answer in each of the following scenarios. Choose your option, then find out what the research revealed.
Mr Jones is 68 years old and has ischemic cardiomyopathy, with LVEF of 30%, CRT-D, and NYHA class III heart failure (HF).
Answer: C. Catheter ablation
Flecainide (option B) (and other class Ic agents) are contraindicated in patients with coronary disease or congestive heart failure (CHF). Amiodarone (option A) has traditionally been a good option for AF control in CHF patients. However, new data from the AATAC-AF study, presented at the American College of Cardiology annual meeting in March in San Diego showed that ablation may improve outcomes in CHF patients who also have implantable devices.
There were 203 patients with persistent AF, LVEF ≤40%, NYHA Class III or IV HF, and CRT or CRT-D randomized to either catheter ablation or amiodarone in this study. At a follow-up of 2 years, there were more patients in the ablation arm compared with the amiodarone arm (70% vs 30%, P <.001) who were free of recurrent of AF. All-cause mortality and hospitalization were also lower in the ablation group (18% vs 8%, P =.037; 57% vs 31%, P <.001, respectively). These patients also had significant improvements in LVEF and 6-minute walk distance as well as quality of life measures.
Soucre: Ablation vs. amiodarone for treatment of atrial fibrillation in patients with congestive heart failure and an implanted ICD/CRTD (AATAC-AF in Heart Failure) ClinicalTrials.gov Identifier: NCT00729911/ P.I. Andrea Natale.
AATAC-AF Slides presented at ACC