Curing Atrial Fibrillation in Heart Failure

Radiofrequency Ablation for Atrial Fibrillation in Advanced Chronic Heart Failure

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.

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