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

The Ablate and Pace Trial (APT) was a prospective registry study of clinical outcomes and survival following ablation and pacing therapy for medically refractory atrial fibrillation. One hundred and fifty-six patients were enrolled at 16 centres in North America. The mean patient age was 66 +/- 11 years, with mean left ventricular ejection fraction of 48% +/- 18%. Seventy-eight percent of the patients had structural heart disease. During one year of follow up, multiple measures of quality-of-life showed significant and sustained improvement following ablation and pacing therapy. Also, left ventricular ejection increased significantly for patients with baseline left ventricular ejection fraction <45%. Metabolic exercise testing showed trends toward improved exercise tolerance; however, these did not achieve statistical significance. The one year overall survival was 85%, with 3% of patients experiencing sudden death. In summary, this large, non-randomized, trial showed significant improvement in quality of life and left ventricular function following ablation and pacing therapy. Ablation and pacing therapy is a viable strategy for palliative management of patients with medically refractory, highly symptomatic atrial fibrillation.