The Australian Intervention Randomized Control of Rate in Atrial Fibrillation Trial (AIRCRAFT). - AIRCRAFT
The goal of this study was to assess the safety and efficacy of atrioventricular junction ablation and pacing (AVJAP) compared with pharmacologic rate control in patients with symptomatic chronic atrial fibrillation (CAF).
Patients Enrolled: 99
Mean Follow Up: 6-12 months
symptomatic CAF and an uncontrolled ventricular rate
ejection fraction (EF) and exercise tolerance
The subjects were 99 patients (mean age 68 years) with symptomatic CAF and an uncontrolled ventricular rate in whom adequate rate control (resting rate <80/minute, exercise rate <150/minute) was achieved with medical therapy during a 3-month screening period. The patients were randomized to medical therapy (n=50) or AVJAP (n=49). An exercise test, Holter monitor, and echocardiogram were performed at baseline and at 6-12 months of follow-up. The primary endpoints were ejection fraction (EF) and exercise tolerance.
The baseline mean EF of 56% did not change significantly at 12 months of follow-up in either the medical (61%) or AVJAP (54%) groups. At 12 months, there was no difference in exercise time between the 2 groups, but the maximum exercise rate was significantly lower in the AVJAP group (112/minute) than in the medical group (153/minute). The maximum Holter rates were 152 and 117/minute in the medical and AVJAP groups, respectively. Compared to medical therapy, AVJAP was associated with an 18% relative reduction in symptoms and a 6% better quality-of-life score.
Among patients with symptomatic chronic atrial fibrillation pharmacologic rate control, AVJAP is not associated with a change in ejection fraction or exercise tolerance, but is more effective in relieving symptoms and improving quality of life. The study implies that AVJAP is appropriate first-line therapy in symptomatic CAF. However, AVJAP resulted in only a modest relative improvement in symptoms, and did not improve exercise tolerance. The clinical benefits of AVJAP are much more apparent when adequate rate control is unattainable pharmacologically. However, it should be kept in mind that catheter ablation to cure AF may be an attractive alternative to AVJAP in selected patients with chronic atrial fibrillation. While the quality of life data is provocative, it is notable that the data is not blinded.
Weerasooriya R, Davis M, Powell A, et al. The Australian Intervention Randomized Control of Rate in Atrial Fibrillation Trial (AIRCRAFT). J Am Coll Cardiol 2003;41:1697-702.
Keywords: Exercise Tolerance, Quality of Life, Heart Conduction System, Atrial Fibrillation, Electrocardiography, Ambulatory, Catheter Ablation, Exercise Test
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