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ACC: Catheter Ablation Tops Amiodarone for Persistent A-Fib

More patients with persistent AF and heart failure are recurrence-free with catheter ablation

TUESDAY, March 17, 2015 (HealthDay News) -- For patients with persistent atrial fibrillation (AF) and heart failure, catheter ablation (CA) is superior to amiodarone (AMIO) for achieving freedom from AF, according to a study presented at the annual meeting of the American College of Cardiology, held from March 14 to 16 in San Diego.

Luigi Di Biase, M.D., Ph.D., from St. David's Medical Center in Austin, Texas, and colleagues compared CA and AMIO for treatment of persistent AF in patients with heart failure. Patients with heart failure and persistent AF, with either an implantable cardioverter defibrillator or cardiac resynchronization therapy-defibrillator, were randomized to undergo CA (102 patients) or receive AMIO (101 patients). In the CA group, pulmonary vein isolation (PVI) plus posterior wall and non-PVI trigger ablation was done in 80 patients, while 22 patients underwent PVI alone.

At 24 months, the researchers found that 70 percent of patients who underwent CA were recurrence-free, compared to 34 percent of those in the AMIO group (P < 0.0001). Success was greater among ablation patients who underwent PVI plus posterior wall and non-PVI trigger ablation (79 percent) compared to PVI alone (36 percent). In secondary outcomes, the researchers found that, compared to AMIO patients, the following were improved for CA patients: change in left ventricular ejection fraction (9.6 versus 4.2 percent; P < 0.001); change in six-minute walking distance (27 versus 8; P < 0.001); and hospitalization at two years (31 versus 57 percent; P < 0.001).

"Among patients with persistent AF and heart failure, CA was superior to AMIO therapy. CA was associated with an improvement in freedom from AF," Di Biase and colleagues conclude. "Other benefits of CA included improvement in left ventricular ejection fraction, six-minute walking distance, and hospitalization at two years."

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