Imperial College London


Faculty of MedicineNational Heart & Lung Institute

Professor of Cardiology



+44 (0)20 7594 3381d.francis Website




Miss Juliet Holmes +44 (0)20 7594 5735




Block B Hammersmith HospitalHammersmith Campus






BibTex format

author = {Jones, DG and Haldar, SK and Hussain, W and Sharma, R and Francis, DP and Rahman-Haley, SL and McDonagh, TA and Underwood, SR and Markides, V and Wong, T},
doi = {10.1016/j.jacc.2013.01.069},
journal = {J Am Coll Cardiol},
pages = {1894--1903},
title = {A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure},
url = {},
volume = {61},
year = {2013}

RIS format (EndNote, RefMan)

AB - OBJECTIVES: This study sought to compare catheter ablation with rate control for persistent atrial fibrillation (AF) in heart failure (HF). BACKGROUND: The optimal therapy for AF in HF is unclear. Drug-based rhythm control has not proved clinically beneficial. Catheter ablation improves cardiac function in patients with HF, but impact on physiological performance has not been formally evaluated in a randomized trial. METHODS: In a randomized, open-label, blinded-endpoint clinical trial, adults with symptomatic HF, radionuclide left ventricular ejection fraction (EF) </=35%, and persistent AF were assigned to undergo catheter ablation or rate control. Primary outcome was 12-month change in peak oxygen consumption. Secondary endpoints were quality of life, B-type natriuretic peptide, 6-min walk distance, and EF. Results were analyzed by intention-to-treat. RESULTS: Fifty-two patients (age 63 +/- 9 years, EF 24 +/- 8%) were randomized, 26 each to ablation and rate control. At 12 months, 88% of ablation patients maintained sinus rhythm (single-procedure success 68%). Under rate control, rate criteria were achieved in 96%. The primary endpoint, peak oxygen consumption, significantly increased in the ablation arm compared with rate control (difference +3.07 ml/kg/min, 95% confidence interval: 0.56 to 5.59, p = 0.018). The change was not evident at 3 months (+0.79 ml/kg/min, 95% confidence interval: -1.01 to 2.60, p = 0.38). Ablation improved Minnesota score (p = 0.019) and B-type natriuretic peptide (p = 0.045) and showed nonsignificant trends toward improved 6-min walk distance (p = 0.095) and EF (p = 0.055). CONCLUSIONS: This first randomized trial of ablation versus rate control to focus on objective exercise performance in AF and HF shows significant benefit from ablation, a strategy that also improves symptoms and neurohormonal status. The effects develop over 12 months, consistent with progressive amelioration of the HF syndrome. (A Randomised Trial to Assess Cat
AU - Jones,DG
AU - Haldar,SK
AU - Hussain,W
AU - Sharma,R
AU - Francis,DP
AU - Rahman-Haley,SL
AU - McDonagh,TA
AU - Underwood,SR
AU - Markides,V
AU - Wong,T
DO - 10.1016/j.jacc.2013.01.069
EP - 1903
PY - 2013///
SN - 1558-3597
SP - 1894
TI - A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure
T2 - J Am Coll Cardiol
UR -
UR -
VL - 61
ER -