Monday, June 11, 2007

Atrial Fibrillation Ablation: Wider is Better

Today a single-center prospective, randomized trial studying the efficacy of wider area catheter ablation around the pulmonary veins for treatment of atrial fibrillation compared to a more localized pulmonary vein isolation was published online before print in Circulation. In this study of 110 patients with paroxysmal or persistent atrial fibrillation, the wider-area catheter ablation procedure proved superior.

This study joins an earlier study from the University of Michigan which demonstrated similar findings in 80 patients. The newer study confirmed, however, that even with wide area ablation procedures, long-term success after a single catheter ablation procedure for atrial fibrillation was 67%.

We've still got a lot to learn since a 20-30% re-do rate (to attempt to achieve success) remains just too high, in my view.

Other investigators have been studying the importance of autonomic ganglia to the initiation and maintenance of atrial fibrillation. Unfortunately, ablating in areas thought to have high density of neural inputs to the heart has also had a high recurrence rate of atrial fibrillation.

Perhaps improvement in atrial fibrillation ablation can be achieved by a combination of the two approaches. But how much ablation is enough? Where should be ablate? Is there an endpoint that always determines success? Or is there a point of diminishing return? Is ablating a significant portion of the left atrial tissue helping or hurting atrial transport if repeated ablations are undertaken?

These and many other questions remain, but one thing is certain...

,,, my day job is secure.


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