ACC Report 2015: Catheter ablation more effective than Amiodarone for atrial fibrillation in heart failure

by Bruce Sylvester: Among patients with heart failure and atrial fibrillation, catheter ablation has led to lower mortality, hospitalization or recurrent atrial fibrillation than treatment with the heart rhythm regulating drug Amiodarone, researchers reported on March 16, 2015 at the American College of Cardiology’s 64th Annual Scientific Session.

“Even when it is effective, Amiodarone often needs to be discontinued after a while due to serious long-term side effects. Our study suggests that in patients with heart failure and atrial fibrillation, catheter ablation is an effective alternative treatment that can help patients avoid or discontinue this drug to reduce the risk of these long-term side effects,” said lead investigator Luigi Di Biase, M.D., Ph.D., a cardiologist and electrophysiologist at St. David’s Medical Center and the Albert Einstein College of Medicine at Montefiore Hospital in New York City.

The researchers enrolled and treated just over 200 subjects in eight European and U.S. hospitals.

All subjects were diagnosed with heart failure, atrial fibrillation, and they had received either an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy with defibrillator (CRT-D).

The researchers randomized half of the subjects to catheter ablation and half to Amiodarone.

At 2 years, 71 percent of subjects treated with catheter ablation had become free of atrial fibrillation, the primary endpoint, and 34 percent of patients treated with Amiodarone had achieved the same outcome.

Thirty-one percent of ablation subjects were hospitalized during the study compared with 57 percent of Amiodarone subjects.

Eight percent of the ablation subjects died during the two-year study compared to 18 percent of the Amiodarone subjects.

Di Biase noted that the type and extent of ablation had an effect on the procedure’s success. “If the ablation is limited to the pulmonary vein alone, the success rate goes down—almost to the level of the Amiodarone treatment,” Di Biase said. “The highest success rates were for procedures in which other areas (in addition to the pulmonary vein) were ablated.”