Catheter Ablation Better Than Drugs for Treating Periodic Atrial Fibrillation

Catheter radio frequency ablation (RFA) to destroy electrical triggers in the heart works as well as or better than drugs in reducing periodic episodes of erratic atrial fibrillation (AF), according to a new study.

Researchers at Aarhus University Hospital (Denmark) conducted a randomized study that included 294 participants randomized to either RFA (146) or an antiarrhythmic drug (148). The patients were assessed at the beginning of the study and again at 3, 6, 12, 18, and 24 months; each time, patients wore a portable heart monitor for seven days. Of the patients primarily treated with ablation, 13 needed supplementary drugs, and 54 patients who did not improve with drugs underwent supplementary RFA.

The results showed that at 3, 6, 12, and 18 months, there was no significant difference in the amount of time patients in the two groups experienced AF in the cumulative AF burden. At 24 months, however, the ablation group did have significantly less AF burden than the drug-treated patients; 22 RFA patients (15%) had AF, compared to 43 (29%) treated with medications. Ten ablation patients (7%) had symptomatic AF episodes, compared to 24 (16%) in the drug group. The study was presented at the American Heart Association (AHA) Scientific Sessions 2011, held during November 2011 in Orlando (FL, USA).

“Ablation therapy is at least as good and tends to be better than drug therapy at preventing episodes of atrial fibrillation,” said lead author and study presenter Prof. Jens Cosedis Nielsen, MD, of the department of cardiology. “Not every patient should be offered ablation, but this research should be discussed with patients when a physician feels it is a viable treatment option.”

AF occurs when the heart's two upper chambers beat erratically. In one form of the condition, paroxysmal AF, patients have bouts of erratic beats that begin spontaneously and usually last less than a week. Antiarrhythmic medications can control the heart rhythm and symptoms of AF, but many patients do not respond well to treatment. AF can lead to serious adverse events such as clots travelling from the heart to obstruct arteries supplying the brain (causing strokes) or other parts of the body causing tissue damage.

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