Ablation Superior to Amiodarone for Atrial Fibrillation in CHF Patients with ICD

MedicalResearch.com Interview with:

Luigi Di Biase, MD, PhD, FACC, FHRS Section Head Electrophysiology Director of Arrhythmia Services Associate Professor of Medicine, Department of Medicine (Cardiology) Albert Einstein College of Medicine at Montefiore Hospital Moses and Weiler Campuses Montefiore-Einstein Center for Heart & Vascular Care Bronx, NY 10467

Dr. Luigi Di Biase

Luigi Di Biase, MDPhD, FACC, FHRS
Section Head Electrophysiology
Director of Arrhythmia Services
Associate Professor of Medicine, Department of Medicine (Cardiology)
Albert Einstein College of Medicine at Montefiore Hospital
Moses and Weiler Campuses
Montefiore-Einstein Center for Heart & Vascular Care
Bronx, NY 10467

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Di Biase: The superiority of catheter ablation of atrial fibrillation (AF) over antiarrhythmic drugs (AADS) has been tested and demonstrated in several randomized clinical trial in patients with normal ejection fraction and paroxysmal AF. Only a few studies are available for patients with heart failure and persistent AF. In this multicenter randomized trial we compared the most utilized AAD for heart failure patients to achieve a rhythm control strategy (Amiodarone) vs ablation of atrial fibrillation in patients with heart failure, persistent AF and ICD. Catheter ablation was superior to Amiodarone to achieve long term freedom from AF. In addition patients undergoing ablation had a lower re-hospitalization rate and importantly a lower mortality.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Di Biase: The take home message is that catheter ablation of AF in HF patient with AF should be considered a valid therapeutic approach and utilized more than what we are used to. In these patients Amiodarone and Dofetilide represents the only drugs that can be used. Amiodarone is associated with important toxicity as also evidenced by our study. Dofetilide is only available in USA and it’s not an easy drug to be used.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Di Biase: Our study shows that ablation is superior to Amiodarone. It also shows that in order for the ablation to be efficacious and superior to Amiodarone, pulmonary veins and many other non pulmonary vein triggers area need to be ablated to achieve success. Future research should focus on better ways and technology to identify and eliminate non pulmonary vein triggers.

Citation:

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

Luigi Di Biase, Prashant Mohanty, Sanghamitra Mohanty, Pasquale Santangeli, Chintan Trivedi, Dhanunjaya Lakkireddy, Madhu Reddy, Pierre Jais, Sakis Themistoclakis, Antonio Dello Russo, Michela Casella, Gemma Pelargonio, Maria Lucia Narducci, Robert Schweikert, Petr Neuzil, Javier Sanchez, Rodney Horton, Salwa Beheiry, Richard Hongo, Steven Hao,Antonio Rossillo, Giovanni Forleo, Claudio Tondo, J. David Burkhardt, Michel Haissaguerre, and Andrea Natale

CIRCULATION AHA.115.019406 Published online before print March 30, 2016,doi: 10.1161/CIRCULATIONAHA.115.019406

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Luigi Di Biase (2016). Ablation Superior to Amiodarone for Atrial Fibrillation in CHF Patients with ICD MedicalResearch.com