TY - JOUR
T1 - Atrial fibrillation in heart failure us ambulatory cardiology practices and the potential for uptake of catheter ablation
T2 - An National Cardiovascular Data Registry (NCDR®) Research to Practice (R2P) project
AU - Mathew, Jehu S.
AU - Marzec, Lucas N.
AU - Kennedy, Kevin F.
AU - Jones, Philip G.
AU - Varosy, Paul D.
AU - Masoudi, Frederick A.
AU - Maddox, Thomas M.
AU - Allen, Larry A.
N1 - Funding Information:
PINNACLE is funded by the American College of Cardiology. Dr Allen is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award No. K23HL105896.
Funding Information:
Dr Masoudi receives support from the ACC for his role as Chief Science Officer of the NCDRâ. Dr Allen reports receiving research grants from the National Institutes of Health, the
Publisher Copyright:
© 2017 The Authors and Medtronic.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Background--Atrial fibrillation (AF) and heart failure with reduced ejection fraction frequently coexist. The AATAC (Ablation versus Amiodarone for Treatment of persistent Atrial fibrillation in patients with Congestive heart failure and an implantable device) trial suggests that catheter ablation may benefit these patients. However, applicability to contemporary ambulatory cardiology practice is unknown. Methods and Results--Using the outpatient National Cardiovascular Data Registry® Practice Innovation and Clinical Excellence Registry, we identified participants meeting AATAC enrollment criteria between 2013 and 2014. Treatment with medications and procedures was assessed at registry inclusion. From 164 166 patients with AF and heart failure, 8483 (7%) patients potentially met AATAC inclusion criteria. Eligible subjects, compared to AATAC trial participants, were older (mean age, 71.2±11.4 years) and had greater comorbidity (coronary artery disease 79.2%, hypertension 82.4%, and diabetes mellitus 31.8%). AF was predominantly paroxysmal (65.5%), rather than persistent/permanent (16.7%) or new onset (17.8%), whereas all patients in the AATAC trial had persistent AF. Commonly used atrioventricular-nodal blocking agents were carvedilol (71.2%), digoxin (31.9%), and metoprolol (27.1%). Rhythm control with anti-arrhythmic drugs was reported in 29.0% of AATAC eligible patients (predominantly amiodarone [24.6%]) and 9.3% had undergone catheter ablation. Patients who underwent ablation were more likely to be younger and have less comorbidities than those who did not. Conclusions--Among the contemporary ambulatory AF/heart failure with reduced ejection fraction population, treatment is predominantly rate control with few catheter ablations. Application of AATAC findings has the potential to markedly increase the use of catheter ablation in this population, although significant differences in clinical profiles might influence ablation outcomes in practice.
AB - Background--Atrial fibrillation (AF) and heart failure with reduced ejection fraction frequently coexist. The AATAC (Ablation versus Amiodarone for Treatment of persistent Atrial fibrillation in patients with Congestive heart failure and an implantable device) trial suggests that catheter ablation may benefit these patients. However, applicability to contemporary ambulatory cardiology practice is unknown. Methods and Results--Using the outpatient National Cardiovascular Data Registry® Practice Innovation and Clinical Excellence Registry, we identified participants meeting AATAC enrollment criteria between 2013 and 2014. Treatment with medications and procedures was assessed at registry inclusion. From 164 166 patients with AF and heart failure, 8483 (7%) patients potentially met AATAC inclusion criteria. Eligible subjects, compared to AATAC trial participants, were older (mean age, 71.2±11.4 years) and had greater comorbidity (coronary artery disease 79.2%, hypertension 82.4%, and diabetes mellitus 31.8%). AF was predominantly paroxysmal (65.5%), rather than persistent/permanent (16.7%) or new onset (17.8%), whereas all patients in the AATAC trial had persistent AF. Commonly used atrioventricular-nodal blocking agents were carvedilol (71.2%), digoxin (31.9%), and metoprolol (27.1%). Rhythm control with anti-arrhythmic drugs was reported in 29.0% of AATAC eligible patients (predominantly amiodarone [24.6%]) and 9.3% had undergone catheter ablation. Patients who underwent ablation were more likely to be younger and have less comorbidities than those who did not. Conclusions--Among the contemporary ambulatory AF/heart failure with reduced ejection fraction population, treatment is predominantly rate control with few catheter ablations. Application of AATAC findings has the potential to markedly increase the use of catheter ablation in this population, although significant differences in clinical profiles might influence ablation outcomes in practice.
KW - Ablation
KW - Antiarrhythmic drug
KW - Atrial fibrillation heart failure
UR - http://www.scopus.com/inward/record.url?scp=85030661689&partnerID=8YFLogxK
U2 - 10.1161/JAHA.116.005273
DO - 10.1161/JAHA.116.005273
M3 - Article
C2 - 28862932
AN - SCOPUS:85030661689
SN - 2047-9980
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 8
M1 - e005273
ER -