Document Detail

Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: a randomised controlled trial.
MedLine Citation:
PMID:  21051458     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine whether or not radiofrequency ablation (RFA) for persistent atrial fibrillation in patients with advanced heart failure leads to improvements in cardiac function.
SETTING: Patients were recruited from heart failure outpatient clinics in Scotland.
DESIGN AND INTERVENTION: Patients with advanced heart failure and severe left ventricular dysfunction were randomised to RFA (rhythm control) or continued medical treatment (rate control). Patients were followed up for a minimum of 6 months.
MAIN OUTCOME MEASURE: Change in left ventricular ejection fraction (LVEF) measured by cardiovascular MRI.
RESULTS: 22 patients were randomised to RFA and 19 to medical treatment. In the RFA group, 50% of patients were in sinus rhythm at the end of the study (compared with none in the medical treatment group). The increase in cardiovascular magnetic resonance (CMR) LVEF in the RFA group was 4.5±11.1% compared with 2.8±6.7% in the medical treatment group (p=0.6). The RFA group had a greater increase in radionuclide LVEF (a prespecified secondary end point) than patients in the medical treatment group (+8.2±12.0% vs +1.4±5.9%; p=0.032). RFA did not improve N-terminal pro-B-type natriuretic peptide, 6 min walk distance or quality of life. The rate of serious complications related to RFA was 15%.
CONCLUSIONS: RFA resulted in long-term restoration of sinus rhythm in only 50% of patients. RFA did not improve CMR LVEF compared with a strategy of rate control. RFA did improve radionuclide LVEF but did not improve other secondary outcomes and was associated with a significant rate of serious complications.
Michael R MacDonald; Derek T Connelly; Nathaniel M Hawkins; Tracey Steedman; John Payne; Morag Shaw; Martin Denvir; Sai Bhagra; Sandy Small; William Martin; John J V McMurray; Mark C Petrie
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-11-04
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  97     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-08     Completed Date:  2011-06-29     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  740-7     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Atrial Fibrillation / physiopathology,  surgery*
Catheter Ablation*
Chronic Disease
Exercise Tolerance
Heart Failure, Systolic / surgery*
Magnetic Resonance Angiography
Middle Aged
Natriuretic Peptide, Brain / metabolism
Quality of Life
Radionuclide Ventriculography
Stroke Volume / physiology
Ventricular Dysfunction, Left / surgery
Young Adult
Grant Support
CZB4475//Chief Scientist Office
Reg. No./Substance:
114471-18-0/Natriuretic Peptide, Brain
Comment In:
Heart. 2011 May;97(9):687-8   [PMID:  21282135 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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