Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes D-PO03 - Poster Session III (ID 48) Poster

D-PO03-131 - Catheter Ablation Versus Medical Rate Control In Atrial Fibrillation And Systolic Dysfunction: Long Term Follow-up Of The Camera-mri Study (ID 1115)

Abstract

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
ITTPPATRA
AblationMedicalP valueAblationMedicalP valueAblationMedicalP value
N303230154715
AF burden, %8.4 ± 15.952.1 ± 47.4≤ 0.0018.4 ± 15.988.4 ± 29.8≤ 0.00110.9 ± 21.488.4 ± 29.8≤ 0.001
Ejection Fraction, %49.1 ± 11.744.0 ± 12.80.1149.1 ± 11.738.7 ± 12.60.0149.0 ± 11.438.7 ± 12.60.005
LA Area, cm227.5 ± 4.933.4 ± 6.60.00227.5 ± 4.937.4 ± 7.3≤ 0.00128.3 ± 4.837.4 ± 7.3≤ 0.001
RA Area, cm221.1 ± 3.724.5 ± 5.20.0221.1 ± 3.728.1 ± 5.2≤ 0.00127.0 ± 6.129.8 ± 3.30.39
Collapse