Ablation vs. Amiodarone for Treatment of Atrial Fibrillation in Patients With Congestive Heart Failure and Implanted ICD/CRTD - AATAC

Jun 06, 2016
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Presenter/Author:
Luigi Di Biase, MD, PhD, FACC
Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Date Presented:
03/16/2015
Date Published:
03/30/2016
Original Posted Date:
06/06/2016
References

Description:

The goal of the trial was to evaluate catheter ablation compared with amiodarone among patients with persistent atrial fibrillation and heart failure.

Contribution to the Literature: The AATAC trial showed that catheter ablation led to a higher procedural success rate (freedom from atrial fibrillation) than amiodarone therapy.


Study Design

  • Randomized
  • Parallel

Patients with persistent atrial fibrillation and heart failure were randomized to catheter ablation (n = 102) versus amiodarone (n = 101). Patients who underwent catheter ablation could undergo a second ablation procedure, if needed in the 3-month blanking period.

In the catheter ablation group, pulmonary vein isolation (PVI) plus posterior wall and non-PVI trigger ablation was done in 80 patients, while PVI alone was done in 22 patients.

Inclusion criteria:

  • Patients with persistent atrial fibrillation
  • Dual-chamber implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D)
  • New York Heart Association (NYHA) class II-III and left ventricular ejection fraction (LVEF) ≤40% within the last 6 months

Patient population:

  • Total number of enrollees: 203
  • Duration of follow-up: 24 months

Principal Findings:

The primary outcome of long-term procedural success occurred in 70% of the catheter ablation group versus 34% of the amiodarone group (p < 0.0001). Success was greater among ablation patients that underwent PVI plus posterior wall and non-PVI trigger ablation (79%) vs. PVI alone (36%).

Secondary outcomes:

  • Change in LVEF: 9.6% vs. 4.2% (p < 0.001), respectively, for ablation vs. amiodarone
  • Change in 6-minute walking distance: 27 vs. 8 (p < 0.001), respectively, for ablation vs. amiodarone)
  • Hospitalization at 2 years: 31% vs. 57% (p < 0.001), respectively, for ablation vs. amiodarone

Interpretation:

Among patients with persistent atrial fibrillation and heart failure, catheter ablation was superior to amiodarone therapy. Catheter ablation was associated with an improvement in freedom from atrial fibrillation. Other benefits of catheter ablation included improvement in LVEF, 6-minute walking distance, and hospitalization at 2 years.

References:

Di Biase L, Mohanty P, Mohanty S, et al. 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. Circulation 2016;133:1637-44.

Presented by Dr. Luigi Di Biase at ACC.15, San Diego, CA, March 16, 2015.

Keywords: ACC Annual Scientific Session, Amiodarone, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Defibrillators, Implantable, Heart Failure, Hospitalization, Recurrence, Risk, Primary Prevention


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