Response by Di Biase et al to Letter Regarding Article, “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”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…777 Selected patients with HFrEF and AF can achieve recovery of LV systolic function after catheter ablation (probably reflecting tachycardiomyopathy). Several smaller trials suggest improved LV function after catheter ablation in HFrEF patients 185,226 -228,778,779 and reduced hospitalizations, 720,777 especially in patients without a previous myocardial infarction. 780 Larger trials are warranted to confirm these findings.…”

Meta‐analysis of randomized controlled trials on atrial fibrillation ablation in patients with heart failure with reduced ejection fraction

“…A total of 1597 articles were screened, only six trials with a total of 775 patients met the inclusion criteria (CA 388 and medical therapy 387). [12][13][14][15][16][17] The basic characteristics of the included studies and patients are summarized in Tables 1 and 2. The mean age was 62.2 AE 7.8 years, and 83% were males.…”

Safety and efficacy of catheter ablation in atrial fibrillation patients with left ventricular dysfunction

“…21 Most recently, a multicenter randomized study showed that CA in AF patient with HF (70%) is superior to amiodarone (34%) in achieving freedom from AF at the 24-month follow up. 9 In our study, we followed up the patients for 30 ± 6 months, and HF patients with CA had a significantly higher SR maintenance rate than those patients on medicine. Multiple factors, variables, and confounders might contribute to the SR maintenance, such as variations in study population with age; gender; AF types; LVEF value; etiology of HF; duration of AF and HF; and heterogeneous ablation strategies, procedures, and operator experience, as well as the difference in selection of ablation strategies, but CA showed independent benefits in AFHF patients.…”

“…With Congestive Heart Failure and an Implanted Device), 9 and CAMERA-MRI trial (Catheter Ablation Versus Medical Rate control in Atrial Fibrillation and Systolic Dysfunction) 10 indicated that CA in HF patients improved 11 freedom from AF and reduced mortality and hospitalization rates, compared to amiodarone therapy. Moreover, the most recent study, CASTLE AF (Catheter Ablation Versus Standard Conventional Treatment in Patients with Left Ventricular Dysfunction and Atrial Fibrillation), 11 just reported that the all-cause mortality and hospitalization for HF were significantly lower in the CA group.…”

“…Multiple factors, variables, and confounders might contribute to the SR maintenance, such as variations in study population with age; gender; AF types; LVEF value; etiology of HF; duration of AF and HF; and heterogeneous ablation strategies, procedures, and operator experience, as well as the difference in selection of ablation strategies, but CA showed independent benefits in AFHF patients. 9,14,[20][21][22] Bunch et al reported that 60.7% of patients had a clinical recurrence of AF after CA at 5-year follow up. 14 In the present study, we observed a similar SR maintenance rate after CA in patients with or without HF as previously reported (>50% vs >90%), 23 and the progressive decreases along with time correlated with the duration of AF history, left atrial size, and types of AF.…”