Evidence map›Paper›PMID 28855115›Full record

Trial reportJournal of the American College of Cardiology2017

Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction: The CAMERA-MRI Study.

Sandeep Prabhu, Andrew J Taylor, Ben T Costello, David M Kaye, Alex J A McLellan, Aleksandr Voskoboinik, Hariharan Sugumar, Siobhan M Lockwood, Michael B Stokes, Bhupesh Pathik and 10 more

Abstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Journal of the American College of Cardiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 286 papers, 22 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
286citing papers in PubMed, 22 pooled it
37.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

286 citing papers in PubMed, 22 syntheses or guidelines pooled it, 612 citations in OpenAlex.

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  14. The impact of catheter ablation in patient's heart failure and atrial fibrillation: a meta-analysis of randomized clinical trials.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2023
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  16. Catheter ablation improves cardiovascular outcomes in patients with atrial fibrillation and heart failure: a meta-analysis of randomized controlled trials.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023
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226 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

20 authors at 4 institutions in 1 country.

Sandeep PrabhuThe Baker Heart & Diabetes Institute, Clinical Electrophysiology Research, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Andrew J TaylorThe Baker Heart & Diabetes Institute, Clinical Electrophysiology Research, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Ben T CostelloThe Baker Heart & Diabetes Institute, Clinical Electrophysiology Research, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia.
David M KayeThe Baker Heart & Diabetes Institute, Clinical Electrophysiology Research, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Alex J A McLellanThe Baker Heart & Diabetes Institute, Clinical Electrophysiology Research, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Aleksandr VoskoboinikThe Baker Heart & Diabetes Institute, Clinical Electrophysiology Research, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Hariharan SugumarThe Baker Heart & Diabetes Institute, Clinical Electrophysiology Research, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Siobhan M LockwoodMonashHeart, Monash Medical Centre, Melbourne, Australia.
Michael B StokesMonashHeart, Monash Medical Centre, Melbourne, Australia.
Bhupesh PathikDepartment of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Chrishan J NalliahDepartment of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Geoff R WongDepartment of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Sonia M AzzopardiThe Baker Heart & Diabetes Institute, Clinical Electrophysiology Research, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia.
Sarah J GutmanThe Baker Heart & Diabetes Institute, Clinical Electrophysiology Research, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia.
Geoffrey LeeDepartment of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
Jamie LaylandFaculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Justin A MarianiThe Baker Heart & Diabetes Institute, Clinical Electrophysiology Research, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Liang-Han LingThe Baker Heart & Diabetes Institute, Clinical Electrophysiology Research, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Jonathan M KalmanDepartment of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Peter M KistlerThe Baker Heart & Diabetes Institute, Clinical Electrophysiology Research, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia. Electronic address: peter.kistler@baker.edu.au.
The Royal Melbourne Hospital · AUBaker Heart and Diabetes Institute · AUMonash Medical Centre · AUMonash University · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAtrial 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 reported modest benefits with a rhythm control strategy.

objectivesThe goal of this study was to determine whether catheter ablation (CA) for AF could improve LVSD compared with medical rate control (MRC) where the etiology of the LVSD was unexplained, apart from the presence of AF.

methodsThis multicenter, randomized clinical trial enrolled patients with persistent AF and idiopathic cardiomyopathy (left ventricular ejection fraction [LVEF] ≤45%). After optimization of rate control, patients underwent cardiac magnetic resonance (CMR) to assess LVEF and late gadolinium enhancement, indicative of ventricular fibrosis, before randomization to either CA or ongoing MRC. CA included pulmonary vein isolation and posterior wall isolation. AF burden post-CA was assessed by using an implanted loop recorder, and adequacy of MRC was assessed by using serial Holter monitoring. The primary endpoint was change in LVEF on repeat CMR at 6 months.

resultsA total of 301 patients were screened; 68 patients were enrolled between November 2013 and October 2016 and randomized with 33 in each arm (accounting for 2 dropouts). The average AF burden post-CA was 1.6 ± 5.0% at 6 months. In the intention-to-treat analysis, absolute LVEF improved by 18 ± 13% in the CA group compared with 4.4 ± 13% in the MRC group (p < 0.0001) and normalized (LVEF ≥50%) in 58% versus 9% (p = 0.0002). In those undergoing CA, the absence of late gadolinium enhancement predicted greater improvements in absolute LVEF (10.7%; p = 0.0069) and normalization at 6 months (73% vs. 29%; p = 0.0093).

conclusionsAF 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 outcome challenges the current treatment paradigm that rate control is the appropriate strategy in patients with AF and LVSD. (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction [CAMERA-MRI]; ACTRN12613000880741).

Indexed as

AgedAtrial FibrillationCatheter AblationElectrocardiography, AmbulatoryFemaleGadoliniumHumansMagnetic Resonance Imaging, CineMaleMiddle AgedProspective StudiesSingle-Blind MethodVentricular Dysfunction, LeftGadoliniumcatheter ablationidiopathic cardiomyopathylate gadolinium enhancementmedical rate controlpersistent AF

Identifiers

PMID28855115
OpenAlexW2747726107

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.