Background: The CAMERA-MRI RCT demonstrated that restoration of sinus rhythm with catheter ablation (CA) significantly improved left ventricular ejection fraction (LVEF) compared with medical rate control (MRC) at 6 months in persistent AF and systolic heart failure. However, the long-term outcomes have not been reported
Objective: To determine long term incidence of AF recurrence and changes to LVEF in the CAMERA-MRI population
Methods: We report AF burden (loop recorders/device in 49 (74.2%)), cardiac function using echocardiogram / cardiac MRI and mortality at long term follow up. CA included PVI and posterior LA wall isolation. Patients were allowed to crossover after 6month study completion
Results: Sixty-six patients (age 61 ±10yrs, AF duration 22 ±16 months and LVEF 34 ±9%) were randomised 1:1 to CA vs MRC. Crossover to CA occurred in 14 with 47 (76%) patients undergoing 1.4 ±0.6 procedures. AF recurred in 27 (57%) with a total burden of 19 ±26% in those with AF recurrence at a mean follow up of 3.9 ±0.9 yrs. On intention to treat analysis (ITT), there was no significant difference in LVEF (49 ± 12 in CA vs 44 ± 13 in MRC, p = 0.11). On Per protocol analysis (PPA) CA was associated with a significant increase in LVEF (49 ± 12% vs 39 ± 13% in MRC p = 0.01). On treatment received analysis (TRA) there was a significant increase in LVEF with CA (49 ± 11% vs 39 ± 13% p = 0.005). There were 4 deaths (cardiac in 1) and 1 resuscitated cardiac arrest. 8 (15%) of the CA group required CRT-D or ICD compared with 7 (47%) in MRC group (p=0.04)
Conclusion: Catheter ablation is superior to medical rate control in improving left ventricular ejection fraction in the long term in patients with atrial fibrillation and systolic heart failure

Table 1: Long-term effect of Catheter ablation compared with MRC: CAMERA-MRI Follow up study

	ITT			PPA			TRA
	Ablation	Medical	P value	Ablation	Medical	P value	Ablation	Medical	P value
N	30	32		30	15		47	15
AF burden, %	8.4 ± 15.9	52.1 ± 47.4	≤ 0.001	8.4 ± 15.9	88.4 ± 29.8	≤ 0.001	10.9 ± 21.4	88.4 ± 29.8	≤ 0.001
Ejection Fraction, %	49.1 ± 11.7	44.0 ± 12.8	0.11	49.1 ± 11.7	38.7 ± 12.6	0.01	49.0 ± 11.4	38.7 ± 12.6	0.005
LA Area, cm2	27.5 ± 4.9	33.4 ± 6.6	0.002	27.5 ± 4.9	37.4 ± 7.3	≤ 0.001	28.3 ± 4.8	37.4 ± 7.3	≤ 0.001
RA Area, cm2	21.1 ± 3.7	24.5 ± 5.2	0.02	21.1 ± 3.7	28.1 ± 5.2	≤ 0.001	27.0 ± 6.1	29.8 ± 3.3	0.39