Atrial fibrillation treatment with catheter shows better results than drug therapy

Jan 27, 2010

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 a study in the January 27 issue of JAMA.

Atrial fibrillation (AF) represents an important public health problem, with patients having an increased long-term risk of stroke, and all-cause death. Although antiarrhythmic drugs are generally used as first-line therapy to treat patients with AF, they are associated with cumulative adverse effects over time and their effectiveness remains inconsistent, according to background information in the article. Catheter ablation has become an alternative therapy for AF.

David J. Wilber, M.D., of Loyola University Medical Center, Maywood, Ill., and colleagues conducted a study to compare catheter ablation with antiarrhythmic (ADT) in patients with symptomatic paroxysmal AF who previously did not respond to at least one antiarrhythmic drug. 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. Patients were randomized to catheter ablation (n = 106) or ADT (n =  61), with assessment for effectiveness in a 9-month follow-up period.

The primary outcome the researchers focused on was time to protocol-defined failure, which included documented symptomatic paroxysmal AF during the evaluation period.

The researchers found that at the end of the 9-month effectiveness evaluation period, 66 percent of patients in the catheter ablation group remained free from protocol-defined treatment failure vs. 16 percent of patients treated with ADT. "Similarly, 70 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," they write. 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.

Major 30-day treatment-related adverse events occurred in 5 of 57 patients (8.8 percent) treated with ADT and 5 of 103 patients (4.9 percent) treated with catheter ablation.

"Our multicenter randomized trial demonstrates the superiority of catheter ablation over ADT in the treatment of patients with paroxysmal AF who did not respond to 1 or more drugs. Catheter ablation provided significantly better rhythm control and improved quality of life with a favorable safety profile. These findings argue for early use of therapy in patients with paroxysmal AF unresponsive to initial attempts with pharmacologic control," the authors conclude.

Explore further: Screening test finds drugs that show promise against Ebola

More information: JAMA. 2010;303[4]:333-340.

add to favorites email to friend print save as pdf

Related Stories

Landmark heart treatment study

Jan 26, 2010

Treating a common heart rhythm disorder by burning heart tissue with a catheter works dramatically better than drug treatments, according to a landmark study published in the Jan. 27 issue of the Journal of the American Me ...

Recommended for you

11th Sierra Leonean doctor dies from Ebola

17 minutes ago

One of Sierra Leone's most senior physicians died Thursday from Ebola, the 11th doctor in the country to succumb to the disease, a health official said.

In the battle against Ebola, a double-layer solution

43 minutes ago

When working with Ebola patients, protective gear works, but removing it can be harrowing. Seeking to protect health care workers from the precarious nature of taking off soiled gloves, Cornell students have ...

New hope for rare disease drug development

11 hours ago

Using combinations of well-known approved drugs has for the first time been shown to be potentially safe in treating a rare disease, according to the results of a clinical trial published in the open access Orphanet Journal of ...

Three weeks since last Ebola case in Mali: WHO

14 hours ago

Mali has not had a case of Ebola for three weeks, the World Health Organization said Wednesday, completing one of the two incubation periods the country needs to be declared free of the virus.

Migraine may double risk for facial paralysis

15 hours ago

Migraine headache may double the risk of a nervous system condition that causes facial paralysis, called Bell's palsy, according to a new study published in the December 17, 2014, online issue of Neurology, the medical journa ...

User comments : 1

Adjust slider to filter visible comments by rank

Display comments: newest first

danwalter
not rated yet Feb 02, 2010
Catheter ablation for afib is dangerous and unproven. The study was bought and paid for by the catheter manufacturer. Read: http://adventures...ogy.com/

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.