Saturday, March 04, 2006

First Prospective Randomized Study in Chronic Afib Ablation

Chronic atrial fibrillation ablation may be coming to fruition after all. The 2 March 06 article from the New England Journal of Medicine by Oral, et al. from the U of Michigan and Milan, Italy researchers published a prospective randomized study of 146 patients with chronic arial fibrillation in which circumferential pulmonary vein isolation was superior to drug therapy at maintaining normal rhythm. 77 patients were randomized to the ablation arm (pulmonary vein isolation) and 69 were randomized to the control arm (amiodarone + 2 cardioversions). In an intention-to-treat analysis, 74 percent of the ablation patients were free from afib without antiarrhythmic medications at one year versus 58 percent of the controls. Of the 69 controls, 53 crossed over to catheter ablation.

The bad news is that over one quarter of the patients had recurrent atrial fibrillation (26%) and often troublesome atypical atrial flutters (6%) requiring a repeat procedure (not a big surprise, given the chronicity of the arrhtyhmia and the size of the atria involved). It is also important to realize that this study was performed collectively in two of the larger a-fib ablation centers worldwide, and results are not likely to be replicated as easily by low-volume centers. Nonetheless, it was encouraging that no other significant complications occurred in this study.

Bottom line: Afib ablation is coming, albeit slowly, and will take lots of patience and perserverence to achieve a 74% cure rate. Hence 26% of folks still will NOT be cured with this technique. We still need better tools, but the technology and techniques continue to improve. My hat's off to these centers and their work...


No comments: