From Our 2010 Archives
Study: Ablation Beats Drugs for Atrial Fibrillation
Catheter Ablation Better Than Drugs at Treating Some Atrial Fibrillation Patients
Reviewed By Louise Chang, MD
Jan. 26, 2010 -- Treating the common heart rhythm disorder known as atrial fibrillation by destroying a small area of heart tissue using a catheter works dramatically better than drug treatments in many patients, a new study confirms.
About 2.2 million Americans have the heart disorder, which occurs when the two upper chambers of the heart, or atria, quiver erratically instead of beating effectively. As a result, blood may pool and clot in the heart, increasing the risk for stroke and heart failure.
Catheter ablation involves the use radiofrequency energy to destroy selected heart tissue in an effort to eliminate the source of the irregular heart rhythm.
In the newly published study, two-thirds of patients who had failed to respond to earlier drug treatments had no symptoms of the irregular heart rhythm nine months after having the catheter ablation procedure.
By comparison, fewer than one in five patients treated with drugs were free of symptoms from atrial fibrillation.
The study appears this week in the Journal of the American Medical Association.
"It is clear that once drugs fail, further attempts to use drug therapy are not useful," lead researcher David Wilber, MD, of Loyola University Chicago Stretch School of Medicine tells WebMD. "Catheter ablation works and it should be used early, before symptoms become persistent."
Atrial Fibrillation: One Patient's Story
The incidence of atrial fibrillation, or A-fib, is on the rise in the United States as the population ages. According to the American Heart Association, as many as 5% of people over the age of 65 have the condition.
Unlike many other heart rhythm disturbances, pacemakers are not commonly used to treat A-fib.
People with A-fib may have no symptoms or they may feel chest pain, heart palpitations, dizziness, shortness of breath, and fainting. The abnormal heart rhythm is often intermittent at first, but it may become persistent.
Diane Clark, 64, had lived with A-fib for 3 1/2 years before having the ablation procedure in December 2009 at Loyola University Medical Center.
"During a bad week, I would have three to five episodes," she tells WebMD. "When I stood up, I was so dizzy I thought I would faint."
The busy chairwoman of a Chicago-area high school English department, Clark was hesitant to have catheter ablation until June of last year.
"I had a nasty fall after waking up at 4 in the morning with A-fib," she says. "I went to get more medicine to calm my heart and the next thing I knew I was on the floor of the bathroom wedged between the toilet and shower. That really frightened me, and I don't frighten easily."
Her procedure took four hours, and recovery took about a week. Clark was back at work in two weeks and she hasn't had an A-fib episode since. She has much more energy than before the catheter ablation, even though she has been under tremendous stress.
Her mother and a close friend died unexpectedly in the weeks following her ablation, and her husband, who has Parkinson's disease, was hospitalized with pneumonia.
"I have more strength than I have had in years," she says. "I don't think I could have gotten through the last few weeks without it."
Catheter Ablation Beats Drugs
The international study conducted by Wilber and colleagues included 167 patients with intermittent, symptomatic episodes of atrial fibrillation who had been treated unsuccessfully with at least one drug for arrhythmia.
All of the patients had experienced at least three symptomatic A-fib episodes within six months of enrollment.
A total of 106 had the catheter procedure and 61 were treated with drugs approved for A-fib treatment that they had not previously taken. Drugs included dofetilide (Tikosyn), flecainide (Tambocor), propafenone (Rythmol), sotalol (Betapace), or quinidine.
After nine months of follow-up, 66% of patients in the catheter ablation group remained free of verified A-fib with symptoms vs. 16% of patients treated with drugs.
Burr Hall, MD, who was involved in the study, says the findings show a clear benefit for patients with intermittent A-fib who have tried drug treatments.
Hall leads the electrophysiology team at the University of Rochester Medical Center in Rochester, N.Y.
"This subset represents a large number of the A-fib patients in this country," he tells WebMD.
Another major study is under way to determine if ablation patients live longer than patients treated with drugs.
American Heart Disease spokesman Kenneth Ellenbogen, MD, says the study should increase awareness within the medical community about the superiority of catheter ablation in this group of patients.
"Catheter ablation is incredibly effective and far more effective than drugs in patients who have already failed drug therapy," he tells WebMD.
SOURCES: Wilber, D.J. Journal of the American Medical Association, Jan. 27,
2010; vol 303: pp 333-340.