Regression of Diffuse Ventricular Fibrosis Following Restoration of Sinus Rhythm With Catheter Ablation in Patients With Atrial Fibrillation and Systolic Dysfunction A Substudy of the CAMERA MRI Trial
Sandeep Prabhu, Ben T Costello, Andrew J Taylor, Sarah J Gutman, Aleksandr Voskoboinik, Alex JA McLellan, Kah Y Peck, Hariharan Sugumar, Leah Iles, Bhupesh Pathik, Chrishan J Nalliah, Geoff R Wong, Sonia M Azzopardi, Geoffrey Lee, Justin Mariani, David M Kaye, Liang-Han Ling, Jonathan M Kalman, Peter M Kistler
JACC Clinical Electrophysiology | ELSEVIER | Published : 2018
OBJECTIVES: This study sought to determine if diffuse ventricular fibrosis improves in patients with atrial fibrillation (AF)-mediated cardiomyopathy following the restoration of sinus rhythm. BACKGROUND: AF coexists in 30% of heart failure (HF) patients and may be an underrecognized reversible cause of left ventricular systolic dysfunction. Myocardial fibrosis is the hallmark of adverse cardiac remodeling in HF, yet its reversibility is unclear. METHODS: Patients with persistent AF and an idiopathic cardiomyopathy (left ventricular ejection fraction [LVEF] ≤45%) were randomized to catheter ablation (CA) or ongoing medical rate control as a pre-specified substudy of the CAMERA-MRI (Catheter ..View full abstract
From the aDepartment of Cardiology, Alfred Hospital, Victoria, Australia; bBaker IDI Heart and Diabetes Institute, Victoria, Australia; cCardiology Department, Royal Melbourne Hospital, Victoria, Australia; dFaculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia; and the eMonash University, Melbourne, Australia. This was an investigator-initiated study. Abbott (Lake Bluff, Illinois) provided 17% of implantable loop recorders used in this study ex gratia; however, Abbott provided no funding and had no role in study design, data collection, data analysis, data interpretation, or writing of the report. This research was in part supported by fellowship stipends provided by the Baker Heart and Diabetes Institute, the National Health and Medical Research Council (NHMRC) of Australia, and the National Heart Foundation of Australia. Dr. Kistler has received funding from Abbott for consultancy and speaking engagements. Dr. Kalman has research and fellowship support from Abbott, Medtronic, Biosense Webster, Boston Scientific, and Abbott; and has received payment for advice to Biosense Webster. Dr. Mariani has received consultancy and speaking fees from Abbott, Medtronic, Biotronik, and Boehringer Ingelheim; and has received funding from Abbott, Boston Scientific, and Medtronic for fellowship support for a clinical assistant. Dr. Ling has received fellowship support from Medtronic, Biotronik. and Abbott. Dr. McLellan has received fellowship support from Abbott. Dr. Sugumar has received fellowship support from Abbott and Medtronic. Mr. Prabhu, Drs. Ling and McLellan, Mr. Voskoboinik, Mr. Nalliah, and Mr. Pathik have received funding from the NHMRC and/or National Heart Foundation of Australia. Mr. Prabhu and Dr. McLellan have received funding from the Baker Heart and Diabetes Research Institute (Melbourne, Australia). Drs. Kalman, Lee, and Kistler are in part supported by the NHMRC. This research is supported in part by the Victorian Government's Operational Infrastructure Funding. Francis Marchlinski, MD, served as Guest Editor for this paper.