Atrioventricular junction ablation followed by resynchronization therapy in patients with congestive heart failure and atrial fibrillation (AVERT-AF) study design.

Atrial fibrillation (AF) and congestive heart failure (CHF) affect millions of patients in the United States. Several studies suggest that AF and in particular the irregular ventricular response might be contributing to the left ventricular dysfunction. Studies that compared pharmacologic rate control to atrioventricular junction (AVJ) ablation followed by right ventricular pacing which restores a regular ventricular response, failed to show an improvement when compared to pharmacological rare control. These results might be explained by the fact that while AVJ ablation restored a regular ventricular response, it subjected patients to the detrimental effects of RV apical pacing. The AVERT-AF trial (Atrio-VEntricular Junction Ablation Followed by Resynchronization Therapy in patients with CHF and AF) is a prospective, randomized, double-blinded, multicenter trial that will be testing the hypothesis that AVJ ablation followed by biventricular pacing significantly improves exercise capacity and functional status compared to pharmacologic rate control in patients with chronic AF and depressed ejection fraction, regardless of rate or QRS duration. A total of 180 patients will be enrolled to test the primary endpoint, which is exercise duration. Patients_enrollment will begin in summer 2006 and is expected to be completed in 2008. The results of this trial should help define the best treatment option for this common arrhythmia in patients with left ventricular dysfunction.