Thursday, November 16, 2006

Pushing the Envelope of Atrial Fibrillation Ablation

A preliminary, pilot, very small, study of 77 patients randomized between primary pulmonary vein isolation versus biventricular pacing with AV junctional ablation was reported at the American Heart Association meeting yesterday. Remarkable “success” was reported with atrial fibrillation ablation compared to the "ablate and pace" approach. But this physician urges caution in interpreting these results.

90% success rates for atrial fibrillation ablation, especially in patients with heart failure is decidedly unusual in the world’s literature. Could there be a bias in their selection of patients or reporting? The data need to be peer-reviewed. Further, anyone who has performed these procedures understands the difficulty performing this procedure from a technical standpoint. Heart failure patients usually have multiple co-morbidities and are at increased risk of complications. Nowhere in this press release were complications reported. Spending 3-5 hours in the left atrium of patients performing these procedures is a big deal for the patient, I believe, compared to implanting a biventricular pacemaker and performing a AV junctional ablation. Furthermore, the procedural preparation time before and follow-up after these atrial fibrillation procedures is considerable. I am aware that the Cleveland Clinic employs eight full time advanced practice nurses to answer between 50 and 100 telephone calls per day from their atrial fibrillation patients – hence these data may not be easily transferable to lower-volume centers.

While I appreciate the novelty of addressing heart failure with atrial fibrillation ablation procedures, patients and physicians alike need to view these data cautiously.


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