BACKGROUND: Atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD) frequently co-exist despite adequate rate-control. Existing randomized studies of AF and LVSD of varying etiologies have demonstrated modest benefits with a rhythm control strategy.
OBJECTIVE: To determine whether catheter ablation (CA) for AF could improve LVSD compared to medical rate-control (MRC) where the etiology of the LVSD was unexplained, apart from the presence of AF.
METHODS: This multi-center randomized clinical trial enrolled patients with persistent AF and idiopathic cardiomyopathy (LVEF ≤45%). After optimization of rate-control, patients underwent cardiac MR (CMR) to assess LVEF and late gadolinium enhancement (LGE), indicative of ventricular fibrosis, before randomization to either CA or ongoing MRC. CA included PVI and posterior wall isolation. AF burden post CA was assessed by implanted loop recorder, and adequacy of MRC by serial Holter-monitoring. The primary endpoint was ΔLVEF on repeat CMR at 6 months.
RESULTS: 301 patients were screened and 68 enrolled between November 2013 and October 2016 and randomized with 33 in each arm accounting for two dropouts. The average AF burden post CA was 1.6% ± 5.0% at six months. On intention to treat analysis, absolute LVEF improved by +18 ± 13% in the CA group compared to +4.4 ± 13% in MRC group, (p <0.0001) and normalized (LVEF ≥50%) in 58% vs 9%, p = 0.0002. In those undergoing CA, the absence of LGE predicted greater improvements in absolute LVEF (+10.7%, p = 0.0069) and normalization at 6 months (73% vs 29%, p = 0.0093).
CONCLUSION: AF is an underappreciated reversible cause of LVSD in this population despite adequate rate control. The restoration of sinus rhythm with CA results in significant improvements in ventricular function, particularly in the absence of ventricular fibrosis on CMR. This challenges the current treatment paradigm that rate control is the appropriate strategy in patients with AF and LVSD.
AbstractText: Whereas Alzheimer disease (AD) is associated with inner retina thinning visualized by spectral-domain optical coherence tomography (SD-OCT), we sought to determine if the retina has a distinguishing biomarker for frontotemporal degeneration (FTD) AbstractText: Using a cross-sectional design, we examined retinal structure in 38 consecutively enrolled patients ...
Reported here are the results of time-resolved X-ray absorption studies on copper-doped cadmium sulfide nanoparticles that provide an explicit description of the electronic dynamics of the ... kinetics of dopant oxidation reveal the presence of two types of surface-bound ions that create midgap states Keyword: X-ray absorption.
AbstractText: To evaluate the impact of adding MRI-US fusion biopsy cores to standard 12-core biopsy in selecting men for Active Surveillance(AS) AbstractText: Among men undergoing a fusion biopsy for evaluation of prostate cancer, we selected men who were eligible for at least ... Keyword: MRI-US fusion biopsy.
... focus of this pictorial essay is to discuss the anatomical details of the rotator interval of the shoulder, correlate the anatomy with normal ultrasound images and present selected pathologies... In this article we demonstrate the capability of high-resolution musculoskeletal ultrasound to visualize the detailed anatomy of the rotator interval.