Investigating the role of myocardial fibrosis in atrial fibrillation and heart failure

2018 Postdoctoral Fellowship

Years funded: 2019-2021

Atrial fibrillation (AF), a common electrical disturbance, or arrhythmia, of the heart, and heart failure (HF), a condition where the pumping ability of the heart is reduced, are two growing epidemics worldwide, including Australia. Both conditions co-exist in up to a third of patients, with AF an increasingly recognised cause of HF in many instances. Restoring normal rhythm (sinus rhythm) in these patients can substantially improve and even eliminate HF in selected patients.

HF is often associated with injury to the heart muscle in the form of scarring. This can be detected and quantified by cardiac magnetic resonance imaging (CMR). Recently, a procedure known as catheter ablation (CA) has established itself as a highly effective in restoring sinus rhythm, in patients with HF and AF - improving heart function, reducing hospitalisation and even death. Nonetheless, the optimal patients to benefit remain to be determined. Whilst the lack of scarring conferred a greater benefit as confirmed in the CAMERA-MRI study, the extent to which pre-existing scar from severe HF or previous heart attacks may determine outcome is unclear.

This randomised study will evaluate if patients with HF and scar benefit from

1. CA compared standard medical therapy and
2. benefit from CA to the same extent as patients without scarring, looking primarily at improvement in heart function and heart failure related hospitalisation at 12 months in addition to improvement in symptoms and functional status.