Catheter Ablation for Atrial Fibrillation and Heart Failure

Pulmonary Vein Isolation for Rhythm Control in Patients With Atrial Fibrillation and Left Ventricular Dysfunction: A Pilot Study

To compare heart function, symptoms, exercise capacity and quality of life in patients with Congestive Heart Failure (CHF) and Atrial Fibrillation (AF)before and after catheter ablation.

Hypothesis: Restoration and maintenance of sinus rhythm by catheter ablation, without the use of antiarrhythmic drugs, in AF and CHF improves heart failure status.

Inclusion Criteria:

• Age 18 years to 80 years
• Clinical diagnosis of CHF based on symptoms (Shortness of breath, fatigue, peripheral edema)
• Systolic left ventricular dysfunction with ejection fraction 40% or less
• NYHA Class I, II or III heart failure
• Paroxysmal AF(2 or more episodes in one month) that terminate within 7 days:or persistent AF (more than 7 days or less than 7 days but terminated with pharmacologic or electrical cardioversion).
• Willing and able to sign informed consent

Exclusion Criteria:

• Previous ablation
• Left atrial size greater than 60mm(parasternal view on transthoracic echocardiogram)
• AF episodes triggered by another uniform arrhythmia(e.g.atrial flutter or atrial tachycardia)
• Active alcohol or drug abuse, which may be causative of AF
• Severe valvular disease requiring surgical repair
• Myocardial infarction within 6 months of enrollment
• Abnormality that prevents catheter introduction
• Coronary surgical revascularization or other cardiac surgery within 6 months of enrollment
• Patients in whom heart transplant expected with 6 months
• AF deemed secondary to a transient or correctable cause (e.g.electrolyte imbalance ,trauma,recent surgery,,infection, toxic ingestion or endocrinopathy
• Pregnancy or women of child bearing potential & not on reliable method of birth control
• Contraindication to Warfarin therapy or other bleeding diathesis
• Participation in another clinical trial
• Inaccessable to follow-up
• Life expectancy of less than 24 months caused by reasons other than heart disease
• Renal failure requiring dialysis
• Decompensated CHF within 48 Hours of enrollment
• Second or third degree AV block or sinus pause greater than 3 seconds, resting heart rate less 30 bpm without a permanent pacemaker
• A history of drug induced Torsades de Pointes or congenital long QT syndrome
• Currently responding to antiarrhythmic drug therapy
• Uninterrupted AF for more than 12 months prior to randomization unless sinus rhythm maintained for 24 hours or longer.
• Unwilling or unable to sign informed consent