Curing Atrial Fibrillation in Heart Failure

• Change in Left Ventricular Ejection Fraction by Magnetic Resonance Imaging (MRI)% [ Time Frame: baseline and 6 months ] [ Designated as safety issue: No ]
  left ventricular ejection fraction (LVEF) is a measure of the % of blood ejected from the ventricle in one heart beat. It is a measure of cardiac function. We measured LVEF at baseline and at 6 months, to assess whether there had been a change in the patients cardiac function over time.
• Baseline Left Ventricular Ejection Fraction by Magnetic Resonance Imaging (MRI) [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  Baseline Left Ventricular Ejection Fraction by Magnetic Resonance Imaging (MRI)in %
• Left Ventricular Ejection Fraction by Magnetic Resonance Imaging (MRI)at 6 Months [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  Left Ventricular Ejection Fraction as measured by Magnetic Resonance Imaging (MRI)at 6 months

• Plasma B-type Natriuretic Peptide (BNP) [ Time Frame: baseline and 6 months ] [ Designated as safety issue: No ]
  venous blood taken to assess levels of the above peptide. High evels of the peptide are associated with adverse prognosis. Blood levels are taken at baseline and 6 months. The change over 6 months is assessed, thereore it is possible to have a negative number if the level falls.
• Plasma B-type Natriuretic Peptide (BNP) at Baseline [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  Plasma B-type Natriuretic Peptide (BNP) measured at basline
• Plasma B-type Natriuretic Peptide (BNP) at 6 Months [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  Plasma B-type Natriuretic Peptide (BNP)

• Right ventricular ejection fraction
• Maintenance of sinus rhythm
• Left and right atrial and ventricular dimensions, areas and volumes
• Left ventricular diastolic function
• NYHA class
• Plasma BNP
• Functional status: 6 minute walk
• Quality of life: Minnesota Living with Heart Failure, SF-36 and Kansas City Cardiomyopathy questionnaires

Heart failure is a condition that occurs when the heart muscle weakens and no longer contracts normally. Half of these patients have an irregularity of heart rhythm called atrial fibrillation (AF). Patients with both heart failure and AF spend more time in hospital, and die earlier than those with heart failure alone. AF is difficult to treat with conventional methods in patients with heart failure. Radiofrequency ablation is a new technique used to cure AF. The investigators aim to establish if radiofrequency ablation for atrial fibrillation in patients with advanced heart failure can result in marked improvement in the function of the heart.

• Chronic Heart Failure
• Atrial Fibrillation

• Procedure: radiofrequency ablation
  isolation of the pulmonary veins with radiofrequency ablation (RFA)
  Other Names:

  • radiofrequency ablation (RFA)
  • pulmonary vein isolation (PVI)
• Drug: ACE inhibitor - ramipril, enalapril, captopril, perindopril, lisinopril
  Evidence based treatment for heart failure. Dose and type will depend on patient tolerability.
• Drug: Beta Blocker (BB) - metoprolol, bisoprolol, carvedilol
  Evidence based treatment for heart failure. Dose and type will depend on patient tolerance.
• Drug: Aldosterone Antagonists - spironolactone
  Evidence based treatment for heart failure. Dose and type will depend on patient to treatment.

• Active Comparator: medical therapy
  Standard therapy for heart failure with angiotensin converting enzyme inhibitors(ACE) - (Ramipril, enalapril, lisinopril, captopril, perindopril), beta-blocker (BB) - (carvedilol, bisoprolol, metoprolol), Aldosterone antagonists (spironolactone) +/- diuretics and digoxin
  Interventions:

  • Drug: ACE inhibitor - ramipril, enalapril, captopril, perindopril, lisinopril
  • Drug: Beta Blocker (BB) - metoprolol, bisoprolol, carvedilol
  • Drug: Aldosterone Antagonists - spironolactone
• Active Comparator: Radiofrequency ablation (RFA)
  Isolation of the pulmonary veins using radiofrequency ablation
  Intervention: Procedure: radiofrequency ablation

Inclusion Criteria:

• Informed consent
• Persistent atrial fibrillation (AF)
• New York Heart Association (NYHA) II, III and IV chronic heart failure (CHF) despite optimal medical therapy for at least 3 months
• left ventricular ejection fraction (LVEF) <35% - as measured by radionuclide ventriculography (RNVG)
• Patients with CHF secondary to ischaemic and non-ischaemic aetiology

Exclusion Criteria:

• QRS duration >150ms (or QRS 120-150 with evidence of mechanical cardiac dysynchrony)
• Magnetic resonance imaging (MRI) - incompatible metallic (ferrous) prosthesis
• Primary valvular disease as a cause of CHF
• Reversible causes of CHF
• Acute myocarditis
• Patients aged 18 or less
• Patients having undergone revascularisation procedures within 6 months
• Paroxysmal AF
• Pregnancy
• Expected cardiac transplantation within 6 months