Helping Hearts Hit the Right Beat

Atrial fibrillation improved with radiofrequency ablation

(RxWiki News) If left untreated, one kind of irregular heartbeat called atrial fibrillation can result in blood clots, stroke or serious heart problems. Beyond taking a pill, there are other ways of trying to correct the problem.

Prescription medication generally is the first treatment for atrial fibrillation (AFib) — the most common type of abnormal heart rhythm.

A new study showed that treatment with radiofrequency ablation resulted in a lower rate of abnormal heart rhythms than prescription medications in treating AFib patients who had not previously been treated.

"Ask your doctor about how to treat an irregular heartbeat."

Carlos A. Morillo, MD, FRCPC, a cardiologist at McMaster University in Hamilton, Canada, was this study’s lead author.

Dr. Morillo and his team wanted to research the use of radiofrequency ablation, a surgical technique that electrical current produced by a radio wave to destroy abnormal heart tissue, as first line treatment for atrial fibrillation. Prescription medications are usually first line treatment. When those medications are not effective, radiofrequency ablation generally is the second treatment choice.

Dr. Morillo and colleagues selected 127 patients from 16 medical facilities in Europe and North America. These researchers treated 61 of those patients with the antiarrhythmia medications flecainide (brand name Tambocor) and propafenone (Rhythmol), and treated 66 of them with radiofrequency ablation. They monitored the patients’ heart health for two years ending in February 2012.

Patients who were assigned antiarrhythima medications had more overly fast heartbeats lasting longer than 30 seconds at a time than the patients who underwent radiofrequency ablation.

Of those taking medications, 44 patients (72 percent) had repeated episodes of irregular heartbeats. Of patients undergoing radiofrequency ablation, 36 (55 percent) had repeated episodes of irregular heartbeats. Electrocardiogram (EKG) tests measured the irregular heart rates and how long they lasted.

AFib that was not accompanied by difficulty breathing, heart palpitations, extreme fatigue or other obvious symptoms of AFib occurred more often in the group of patients taking medications than in the group undergoing ablation. Of the patients who were prescribed medications, 11 (18 percent) had AFib with no obvious symptoms. In the other group, nine patients (9 percent) had AFib without outward symptoms.

AFib accompanied by symptoms occurred repeatedly more often in patients taking medications than in those treated with ablation. In the medication-taking group, 36 patients (59 percent) had recurring bouts of AFib with symptoms. In the ablation group, 31 patients (47 percent) had recurring bouts of AFib.

Treatment improved everyday quality of life for both groups, who also had about the same quality of life.

No deaths or strokes were reported in either group. However, four cases of dangerous fluid build-up around the heart occurred in the ablation group.

"Radiofrequency ablation of atrial fibrillation has surged in popularity as electrophysiologists have refined and upgraded their techniques," said Sarah Samaan, MD, cardiologist and physician partner at the Baylor Heart Hospital in Plano, Texas. "As this study shows, there is no perfect solution for many people to the aggravation of atrial fibrillation. However, when performed in appropriate patients by experienced physicians, ablation has the advantages of being more effective without the potential side effects of drug therapy."

According to Dr. Samaan, "It's important to understand that ablation is not for everyone. People with enlarged or weakened hearts may be less likely to benefit. Those with other serious medical conditions, like chronic lung disease (which often aggravates atrial fibrillation) may not be good candidates. And the longer that you are persistently in atrial fibrillation, the less likely the procedure is to be effective. There are also potentially serious (even fatal) side effects such as stroke and puncture of the heart walls that need to be discussed and understood prior to going ahead with the procedure. But for many people, atrial fibrillation ablation can be life changing."

Dr. Morillo and team concluded that more research on the effectiveness of ablation as a first choice for treatment is needed.

"These findings highlight the fact that although ablation is effective, there are still approximately 50 percent of patients who have [AFib] recurrences 24 months after undergoing a single procedure," the researchers wrote. "Ablation extends the time free of both symptomatic and asymptomatic [AFib] and significantly reduced the recurrence of repeated episodes, potentially having an effect on [AFib] progression."

This study was published online February 19 in JAMA.

Biosense Webster, maker of heart catheters, and McMaster University’s Population Health Research Institute funded the study.

Each of the study’s 10 researchers reported having received research grants and/or consulting fees from pharmaceutical makers or research hospitals.

Review Date: 
February 18, 2014