The North American experience with the Ablate and Pace Trial (APT) for medically refractory atrial fibrillation

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Atrial fibrillation is a common arrhythmia often refractory to medical management.
• Medically refractory atrial fibrillation significantly impacts quality of life and cardiac function.

Purpose of the Study:

• To evaluate clinical outcomes and survival after ablation and pacing therapy in patients with medically refractory atrial fibrillation.
• To assess the impact of this therapy on quality of life, left ventricular function, and exercise tolerance.

Main Methods:

• Prospective registry study (Ablate and Pace Trial) enrolling 156 patients across 16 North American centers.
• Patients received ablation and pacing therapy for medically refractory atrial fibrillation.
• Clinical outcomes, quality of life, left ventricular ejection fraction, and exercise tolerance were assessed over one year.

Main Results:

• Significant and sustained improvements in quality of life were observed one year post-therapy.
• Left ventricular ejection fraction significantly increased in patients with baseline LVEF <45%.
• One-year overall survival was 85%, with 3% experiencing sudden death; exercise tolerance showed non-significant trends toward improvement.

Conclusions:

• Ablation and pacing therapy demonstrates significant improvements in quality of life and left ventricular function.
• This therapy is a viable strategy for the palliative management of highly symptomatic patients with medically refractory atrial fibrillation.