Imperial College London
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DrRakeshSharma

Faculty of Medicine, National Heart & Lung Institute

Honorary Clinical Senior Lecturer
 
 
 
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rakesh.sharma

 
 
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Location

 

Department of CardiologyRoyal BromptonRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Jones:2013:10.1016/j.jacc.2013.01.069,
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 = {http://dx.doi.org/10.1016/j.jacc.2013.01.069},
volume = {61},
year = {2013}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
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  - http://dx.doi.org/10.1016/j.jacc.2013.01.069
UR  - http://www.ncbi.nlm.nih.gov/pubmed/23500267
VL  - 61
ER  -
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