@article{2bb56ae8fb5143779343fbd46b6848a2,
title = "Catheter Ablation Versus Medication in Atrial Fibrillation and Systolic Dysfunction: Late Outcomes of CAMERA-MRI Study",
abstract = "Objectives: This study sought to determine the long-term outcomes of restoring sinus rhythm with catheter ablation (CA). Background: The CAMERA-MRI (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Heart Failure—An MRI-Guided Multicenter Randomized Controlled Trial) study demonstrated that restoration of sinus rhythm with CA significantly improved left ventricular ejection fraction (LVEF) compared with medical rate control (MRC) at 6 months in persistent atrial fibrillation and otherwise unexplained systolic heart failure. However, the long-term outcomes have not been reported. Methods: Patients enrolled in the CAMERA-MRI study were followed for 4 years with echocardiogram and cardiac magnetic resonance. CA involved pulmonary vein isolation and posterior left atrial wall isolation in 94%. Patients crossed over to CA after 6-month study duration. Arrhythmia burden was determined with implanted cardiac monitors or cardiac devices. Results: Sixty-six patients (age 62 ± 10 years, atrial fibrillation duration of 22 ± 16 months, and LVEF 33 ± 9%) were randomized 1:1 to CA versus MRC. Eighteen of 33 patients crossed over from MRC group to CA group. At 4.0 ± 0.9 years, atrial fibrillation recurred in 27 patients (57%) in the CA group with a mean burden of 10.6 ± 21.2% after 1.4 ± 0.6 procedures. There was an absolute increase in LVEF with CA of 16.4 ± 13.3% compared with 8.6 ± 7.6% in MRC (p = 0.001). In the CA group, the absence of ventricular late gadolinium enhancement was associated with a greater improvement in absolute LVEF (19 ± 13% vs. 10 ± 11% in the late gadolinium enhancement–positive group; p = 0.04) and LVEF normalization in 19 patients (58%) versus 4 patients (18%) in the late gadolinium enhancement–positive group (p = 0.008) at 4.0 ± 0.9 years follow-up. Conclusions: CA is superior to MRC in improving LVEF in the long term in patients with atrial fibrillation and systolic heart failure. The greatest recovery in systolic function was demonstrated in the absence of ventricular fibrosis on cardiac magnetic resonance.",
keywords = "atrial fibrillation, cardiomyopathy, catheter ablation, long-term outcomes, maintained, reversible",
author = "Hariharan Sugumar and Sandeep Prabhu and Ben Costello and David Chieng and Sonia Azzopardi and Aleksandr Voskoboinik and Ramanathan Parameswaran and Wong, {Geoffrey R.} and Robert Anderson and Al-Kaisey, {Ahmed M.} and Liang-Han Ling and Emily Kotschet and Taylor, {Andrew J.} and Kalman, {Jonathan M.} and Kistler, {Peter M.}",
note = "Funding Information: Dr. Sugumar has received support from a co-funded National Health and Medical Research Committee/National Health Foundation post-graduate scholarships and Royal Australian College of Physicians J.J. Billings and Centre of Research Excellence in Cardiovascular Outcomes Improvement scholarships. Prof. Jonathan M. Kalman has received a National Health and Medical Research Committee practitioner fellowship; and research and fellowship support from Medtronic and Biosense Webster, all outside the submitted work. Prof. Peter M. Kistler has received funding from Abbott Medical for consultancy and speaking engagements, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Sanjay Dixit, MD, served as Guest Editor for this paper. William Stevenson, MD, served as Guest Editor-in-Chief for this paper. Funding Information: Dr. Sugumar has received support from a co-funded National Health and Medical Research Committee/National Health Foundation post-graduate scholarships and Royal Australian College of Physicians J.J. Billings and Centre of Research Excellence in Cardiovascular Outcomes Improvement scholarships. Prof. Jonathan M. Kalman has received a National Health and Medical Research Committee practitioner fellowship; and research and fellowship support from Medtronic and Biosense Webster, all outside the submitted work. Prof. Peter M. Kistler has received funding from Abbott Medical for consultancy and speaking engagements, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Sanjay Dixit, MD, served as Guest Editor for this paper. William Stevenson, MD, served as Guest Editor-in-Chief for this paper. Publisher Copyright: {\textcopyright} 2020 American College of Cardiology Foundation",
year = "2020",
month = dec,
day = "14",
doi = "10.1016/j.jacep.2020.08.019",
language = "English",
volume = "6",
pages = "1721--1731",
journal = "JACC: Clinical Electrophysiology",
issn = "2405-500X",
publisher = "Elsevier",
number = "13",
}