6/27/23, 11:46 PM AATAC Pathway Feedback Search Clinical Topics Home Studies AATAC AATAC Disease Disease Atrial fibrillation Heart failure Trial question Is catheter ablation superior to amiodarone for the treatment of persistent AF in patients with HF? Study design Multi-center Open label RCT Population Characteristics of study participants 26.0% female N = 203 74.0% male 203 patients (52 female, 151 male) Inclusion criteria: patients with persistent AF, dual-chamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator, NYHA II to III and LVEF < 40% within the past 6 months Key exclusion criteria: AF caused by a reversible etiology, and presence of valvular or coronary heart disease requiring surgical intervention, early postoperative AF (within 3 months of surgery), or a life expectancy 2 years, prolonged QT interval, hypothyroidism, history of severe pulmonary disease, and liver failure, or patients receiving a regular dose of AMIO ( 200 mg/d) Interventions N=102 catheter ablation (pulmonary vein antrum isolation with an open-irrigation tip catheter ablation) https://web.pathway.md/studies/recZz6PABQVeju5iO 1/2 6/27/23, 11:46 PM AATAC Pathway N=101 amiodarone (loading dose given in divided doses of 400 mg PO BID for 2 weeks followed by 400 mg daily for the next 2 weeks, followed by a maintenance dose of 200 mg daily) Primary outcome Freedom from atrial fibrillation recurrence 70.0 % 70 52.5 % 35.0 % 34 Significant increase 17.5 % NNT = 3 0.0 % Catheter ablation Amiodarone Significant increase in freedom from AF recurrence (70% vs. 34%; RR 2.05, 95% CI 0.83 to 3.27) Secondary outcomes Significant decrease in the rate of unplanned hospitalization over the 2-year follow-up (31% vs. 57%; RR 0.55, 95% CI 0.39 to 0.76) Significant decrease in death from all causes (8% vs. 18%; RR 0.44, 95% CI -0.2 to 0.96) Safety outcomes No significant differences in groin hematoma, pericardial effusion. Significant differences in change in LVEF (8.3% vs. 5.0%), 6-minute walk distance (19 m vs. 6 m), and Minnesota Living with HF Questionnaire (10 vs. 5.0). Conclusion In patients with persistent AF, dual-chamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator, NYHA II to III and LVEF < 40% within the past 6 months, catheter ablation was superior to amiodarone with respect to freedom from AF recurrence. Reference Di Biase L, Mohanty P, Mohanty S et al. Ablation Versus 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 Apr 26;133(17):1637-44. Open reference URL https://web.pathway.md/studies/recZz6PABQVeju5iO 2/2