Radiofrequency Ablation Not Superior to Medical Therapy for HF, Persistent Atrial Fibrillation





Radiofrequency ablation for patients with heart failure and persistent atrial fibrillation (AF) did not improve efficacy compared with medical therapy, but was associated with greater complications, according to results presented here at the European Society of Cardiology’s Heart Failure Congress 2010.

Michael R. MacDonald, MD, Golden Jubilee National Hospital, Glasgow, Scotland, presented the findings on May 30 during a Late-Breaking Trials Session.

The study was conducted to compare optimal medical therapy (rate control) with radiofrequency ablation (rhythm control) in adult patients with symptomatic heart failure, severe left ventricular dysfunction, and persistent AF.

After a baseline cardiovascular magnetic resonance (CMR) study was performed, patients who qualified were randomised to optimal medical therapy or radiofrequency ablation.

All patients in the optimal medical therapy group were treated with renin angiotensin system blocker plus beta-blockers with or without spironolactone for at least 3 months; if the mean heart rate was >80 beats per minute over 24 hours, digoxin was added to the regimen.

In the radiofrequency ablation group, patients were treated with optimal medical therapy plus radiofrequency ablation. After the initial ablation, patients also received 3 months of oral amiodarone. A repeat CMR was performed at 1 week after ablation. At 3 months post ablation, a second radiofrequency ablation was performed if rhythm was poorly controlled.

In both groups, all tests were repeated at 6 months. The primary outcome was change in left ventricular ejection fraction (LVEF) by CMR.

Of 41 patients randomised, 18 in the medical therapy group and 20 in the ablation group were analysed. One patient from each group withdrew from the study.

The success rate of ablations was that 10 patients were in sinus rhythm at 3 months, 2 of whom were in AF at the final visit; of the 10 who were in AF at 3 months, 6 agreed to a second ablation, and 2 of these were in sinus rhythm at the final visit.

There was no significant difference between groups in change in LVEF by CMR from baseline to final visit (+2.8% for the medical therapy group and +4.5% for the ablation group; P = .06). There were 4 major complications of the ablation procedure: one stroke 6 days after the initial procedure, 2 cardiac tamponades, and 1 heart failure hospitalisation within 1 week of the procedure.