Atrial Fibrillation Treatment Using Specialized Catheter Results in Better Outcomes Compared to Drug Therapy
A study published in the Journal of the American Medical Association (JAMA) this week found that treatment for atrial fibrillation (AF) using a specialized catheter results in better outcomes for patients compared to drug therapy. One of the co-authors of the article is Burr Hall, M.D., Heart Station Director, Assistant Professor of Medicine, Division of Electrophysiology, University of Rochester Medical Center. Dr. Hall was the Principal Investigator (PI) at the University of Rochester Medical Center and led one of the highest-enrolling centers in the U.S.
The study concluded that use of catheter ablation, in which radiofrequency energy is emitted from a catheter to eliminate the source of an irregular heartbeat, resulted in significantly better outcomes in patients with paroxysmal atrial fibrillation (intermittent cardiac rhythm disturbance) who had not responded previously to antiarrhythmic drug therapy, According to Dr. Hall, “the study is of major significance because it is the first one involving multiple high-volume ablation centers that demonstrated that ablation was more effective than drug therapy in treating atrial fibrillation.” In short, 66 percent of patients in the catheter group had avoided treatment failure at the end of the nine-month study, versus 16 percent of patients treated with drug therapy, with obvious implications for clinical practice.
The randomized study was conducted at 19 hospitals and included 167 patients who had experienced at least three AF episodes within six months before randomization. Enrollment occurred between Oct. 2004 and Oct. 2007, with the last follow-up on January 19, 2009. The primary outcome the researchers focused on was time to protocol-defined failure, which included documented symptomatic paroxysmal AF during the evaluation period.
Patients with AF have an increased long-term risk of stroke, heart failure and all-cause death. Although antiarrhythmic drugs are generally used as first-line therapy to treat patients with AF, overtime they are associated with cumulative adverse effects and their effectiveness remains inconsistent. Catheter ablation has become an alternative therapy for AF.
Seventy percent of patients treated by catheter ablation remained free of symptomatic recurrent atrial arrhythmia vs. 19 percent of patients treated with ADT. In addition, 63 percent of patients treated by catheter ablation were free of any recurrent atrial arrhythmia vs. 17 percent of patients treated with ADT. Patients in the catheter ablation group also reported significantly better average symptom frequency and severity scores at three months on measures of quality of life.
Catheter ablation provided significantly better rhythm control and improved quality of life with a favorable safety profile. These findings argue for early use of catheter ablation therapy in patients with paroxysmal AF unresponsive to initial attempts with pharmacologic control,” the authors conclude.(JAMA. 2010;303[4]:333-340.)