Rate vs rhythm control in atrial fibrillation (AF) is still an unsettled and often debated issue. But it is often noted that left ventricular systolic dysfunction coexist in spite of adequate rate control in AF. CAMERA-MRI Study  screened 301 patients with AF and systolic dysfunction to exclude ventricular fibrosis as evidenced by late gadolinium enhancement on cardiac magnetic resonance imaging (CMR). Of the 68 patients who did not have ventricular fibrosis, half each were enrolled for medical rate control and catheter ablation of AF. Pulmonary vein isolation and posterior wall isolation was the ablation strategy. AF burden in the catheter ablation group was assessed by an implantable loop recorder (ILR), while rate control in the medical rate control group was assessed with serial Holter recordings. Mean AF burden in the ablation group was 1.6% and the mean improvement in left ventricular ejection fraction was 18% compared to 4.4% in the medical rate control group. Hence authors of the Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction (CAMERA-MRI) study concluded that AF is an underappreciated reversible cause of left ventricular systolic function despite adequate rate control.
- Prabhu S et al. Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction. The CAMERA-MRI Study. J Am Coll Cardiol. 2017, 70 (16) 1949-1961.