Ablation better than amiodarone for persistent AF with congestive heart failure
AATAC Multicenter Randomized Trial  has demonstrated that catheter ablation is clearly superior to amiodarone for heart failure and persistent AF having an implanted device. The study involved about two hundred patients with dual chamber defibrillator or cardiac resynchronization therapy and left ventricular ejection fraction less than 40% with functional class of New York Heart Association II or III. The primary endpoint was recurrence of atrial fibrillation while secondary endpoints were all cause mortality and unplanned hospitalization. All the endpoints were better in the catheter ablation group compared to amiodarone group.
In general, success rates of catheter ablation of persistent AF is less than that of paroxysmal AF. This is more so if it is long standing persistent AF (more than 12 months), Recurrence of atrial fibrillation is also higher after ablation of persistent atrial fibrillation than paroxysmal atrial fibrillation.
- Di Biase L, Mohanty P, Mohanty S, Santangeli P, Trivedi C, Lakkireddy D, Reddy M, Jais P, Themistoclakis S, Dello Russo A, Casella M, Pelargonio G, Narducci ML, Schweikert R, Neuzil P, Sanchez J, Horton R, Beheiry S, Hongo R, Hao S, Rossillo A, Forleo G, Tondo C, Burkhardt JD, Haissaguerre M, Natale A. Ablation vs. Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial. Circulation. 2016; 133: 1637-1644.