AATAC
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
74.0% male
N = 203
203 patients (52 female, 151 male)
Inclusion criteria: patients with persistent AF, dual-chamber implantable cardioverter defibrillator or CRT 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 artery 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)
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
34
70.0 %
52.5 %
35.0 %
17.5 %
0.0 %
Catheter ablation
Amiodarone
Significant increase ▲
NNT = 2
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 CRT 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.
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