Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: A randomised controlled trial

Objective: To determine whether or not radiofrequency ablation ( RFA ) for persistent atrial fibrillation in patients with advanced heart failure leads to improvements in cardiac function. Setting: Patients were recruited from heart failure outpatient clinics in Scotland. Design and intervention: Patients with advanced heart failure and severe left ventricular dysfunction were randomised to RFA ( rhythm control ) or continued medical treatment ( rate control ). Patients were followed up for a minimum of 6 months. Main outcome measure: Change in left ventricular ejection fraction ( LVEF ) measured by cardiovascular MRI. Results: 22 patients were randomised to RFA and 19 to medical treatment. In the RFA group, 50% of patients were in sinus rhythm at the end of the study ( compared with none in the medical treatment group ). The increase in cardiovascular magnetic resonance ( CMR ) LVEF in the RFA group was 4.5±11.1% compared with 2.8±6.7% in the medical treatment group ( p=0.6 ). The RFA group had a greater increase in radionuclide LVEF ( a prespecified secondary end point ) than patients in the medical treatment group ( +8.2±12.0% vs +1.4±5.9%; p=0.032 ). RFA did not improve N-terminal pro-B-type natriuretic peptide, 6 min walk distance or quality of life. The rate of serious complications related to RFA was 15%. Conclusions: RFA resulted in long-term restoration of sinus rhythm in only 50% of patients. RFA did not improve CMR LVEF compared with a strategy of rate control. RFA did improve radionuclide LVEF but did not improve other secondary outcomes and was associated with a significant rate of serious complications. Clinical trials registration number: NCT00292162.