Curing Atrial Fibrillation in Heart Failure

Not Applicable

Completed

Interventions: Drug: ACE inhibitor - ramipril, enalapril, captopril, perindopril, lisinopril
Procedure: radiofrequency ablation
Drug: Beta Blocker (BB) - metoprolol, bisoprolol, carvedilol
Drug: Aldosterone Antagonists - spironolactone

Brief Summary: 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.

Recruitment & Eligibility

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

Arm && Interventions

Group	Intervention	Description
medical therapy	ACE inhibitor - ramipril, enalapril, captopril, perindopril, lisinopril	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
medical therapy	Beta Blocker (BB) - metoprolol, bisoprolol, carvedilol	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
medical therapy	Aldosterone Antagonists - spironolactone	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
Radiofrequency ablation (RFA)	radiofrequency ablation	Isolation of the pulmonary veins using radiofrequency ablation

Primary Outcome Measures

Name	Time	Method
Baseline Left Ventricular Ejection Fraction by Magnetic Resonance Imaging (MRI)	Baseline	Baseline Left Ventricular Ejection Fraction by Magnetic Resonance Imaging (MRI)in %
Change in Left Ventricular Ejection Fraction by Magnetic Resonance Imaging (MRI)%	baseline and 6 months	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.
Left Ventricular Ejection Fraction by Magnetic Resonance Imaging (MRI)at 6 Months	6 months	Left Ventricular Ejection Fraction as measured by Magnetic Resonance Imaging (MRI)at 6 months

Secondary Outcome Measures

Name	Time	Method
Plasma B-type Natriuretic Peptide (BNP)	baseline and 6 months	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	Baseline	Plasma B-type Natriuretic Peptide (BNP) measured at basline
Plasma B-type Natriuretic Peptide (BNP) at 6 Months	6 months	Plasma B-type Natriuretic Peptide (BNP)