CAMERA-MRI II trial: Catheter Ablation versus Medical Rate Control of Atrial Fibrillation with Systolic Heart Failure and Myocardial Fibrosis – an MRI Guided Multi-Centre Randomised Controlled Clinical Trial

Abstract

Heart failure (HF) is a common heart condition whereby the heart muscle is weakened and the pumping capacity is significantly impaired. Atrial fibrillation (AF) is a common electrical disturbance of the heart which results in rapid and irregular heart beats which may cause or significantly worsen HF.

Catheter ablation is a minimally invasive procedure involving the use of specialized instruments through the groin to make a small burn in the area of the heart that is responsible for irregular heart rates. This procedure can eliminate AF in many patients, however, in patients with both AF and HF, it is difficult to determine whether all patients will experience an improvement in symptoms and heart muscle function. In particular, patients who have had a heart attack often have scarring in the heart which may not recover. The amount of scarring in the heart muscle can be detected on MRI and usually the more scarring there is, the less likely the heart will recover.

This study will explore the influence of scar on patients undergoing catheter ablation to assess the degree of recovery of heart function and improvement in HF symptoms, functional capacity and survival.

We propose that MRI may help to stratify which patients with both AF and HF will derive the most benefit from catheter ablation. This study builds upon the previous CAMERA-MRI study and similar studies of catheter ablation in HF, by evaluating how scarring of the heart influences catheter ablation in patients with AF and HF.