{"id":"e600ba5cacf2","type":"article","url":"https://hartvaat.nl/2017/10/17/katheterablatie-versus-frequentiecontrole-bij-af-met-systolische-disfunctie-came/","title":"Katheterablatie versus frequentiecontrole bij AF met systolische disfunctie: CAMERA-MRI","title_en":"Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction: The CAMERA-MRI Study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.08.041","source_url":"https://doi.org/10.1016/j.jacc.2017.08.041","authors":["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","Chrishan J Nalliah","Geoff R Wong","Sonia M Azzopardi","Sarah J Gutman","Geoffrey Lee","Jamie Layland","Justin A Mariani","Liang-Han Ling","Jonathan M Kalman","Peter M Kistler"],"significance":7,"published":"2017-10-17","source_date":"2017-10-17","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The CAMERA-MRI study showed that catheter ablation improved left ventricular function compared with rate control in AF patients with systolic dysfunction, assessed by cardiac MRI. The results supported ablation as a therapeutic strategy for AF-related cardiomyopathy.","created":"2026-07-03T10:26:57Z","updated":"2026-07-03T13:26:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"CAMERA-MRI-studie die katheterablatie vergeleek met medicamenteuze frequentiecontrole bij AF-patiënten met systolische disfunctie. MRI-eindpunten voor objectieve evaluatie.","abstract_original":"BACKGROUND: Atrial 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. OBJECTIVES: The 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. METHODS: This 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. RESULTS: A 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). CONCLUSIONS: AF 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)."}