title: A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial).
abstract: BACKGROUND
  Restoring sinus rhythm in patients with heart failure (HF) and atrial fibrillation (AF) may improve left ventricular (LV) function and HF symptoms. We sought to compare the effect of a catheter ablation strategy with that of a medical rate control strategy in patients with persistent AF and HF.
  
  
  RESULTS
  Patients with persistent AF, symptomatic HF, and LV ejection fraction <50% were randomized to catheter ablation or medical rate control. The primary end-point was the difference between groups in LV ejection fraction at 6 months. Baseline LV ejection fraction was 32±8% in the ablation group and 34±12% in the medical group. Twenty-six patients underwent catheter ablation, and 24 patients were rate controlled. Freedom from AF was achieved in 21/26 (81%) at 6 months off antiarrhythmic drugs. LV ejection fraction at 6 months in the ablation group was 40±12% compared with 31±13% in the rate control group (P=0.015). Ablation was associated with better peak oxygen consumption (22±6 versus 18±6 mL/kg per minute; P=0.014) and Minnesota living with HF questionnaire score (24±22 versus 47±22; P=0.001) compared with rate control.
  
  
  CONCLUSIONS
  Catheter ablation is effective in restoring sinus rhythm in selected patients with persistent AF and HF, and can improve LV function, functional capacity, and HF symptoms compared with rate control. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01411371.
authors.affiliation: Department of Cardiology, St Bartholomew's Hospital, Bart's & The London NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary, University of London, London, United Kingdom.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Hunter
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Berriman
authors.forename: Ihab
authors.initials: I
authors.lastname: Diab
authors.forename: Ravindu
authors.initials: R
authors.lastname: Kamdar
authors.forename: Laura
authors.initials: L
authors.lastname: Richmond
authors.forename: Victoria
authors.initials: V
authors.lastname: Baker
authors.forename: Farai
authors.initials: F
authors.lastname: Goromonzi
authors.forename: Vinit
authors.initials: V
authors.lastname: Sawhney
authors.forename: Edward
authors.initials: E
authors.lastname: Duncan
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Page
authors.forename: Waqas
authors.initials: W
authors.lastname: Ullah
authors.forename: Beth
authors.initials: B
authors.lastname: Unsworth
authors.forename: Jamil
authors.initials: J
authors.lastname: Mayet
authors.forename: Mehul
authors.initials: M
authors.lastname: Dhinoja
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Earley
authors.forename: Simon
authors.initials: S
authors.lastname: Sporton
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schilling
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects; D011788:Quality of Life; D020127:Recovery of Function; D012008:Recurrence; D013318:Stroke Volume / Q000187:drug effects; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: atrial fibrillation; catheter ablation; heart failure