One of the better reviews of atrial fibrillation ablation's current state of the art was recently reviewed by John D. Fisher (no relation) and colleagues from Montefiore Medical Center's section of Cardiology in PACE (Pacing Clin Electrophysiol. 2006;29(5):523-537). A link to the online version of the article can be found via Medscape (registration required). It's a worthwhile read full of good basic information and an objective compillation of the reported studies to date.
--Wes
3 comments:
Don't have any firsthand knowledge of afib ablations (left the EP lab 10 yrs ago), but an EP friend in private practice says her success rate has improved from about 50% doing pulm vein isolation to about 75% with using mapping equipment - this seems to correspond to the article. And that the patients were not the usual that I see at the VA (i.e., were generally lone afib or essentially nl LA size rather than huge LAE). As far as I know, the only VA in my neck of the woods doing afib ablation is in LA - can't easily refer there. So our patients are stuck with rate control if they fail CV and meds.
There is a local private hospital that routinely does CABG w/ MAZE on pts with fib. Several of our VA patients had surgery there and had MAZE done and none remain in NSR. Makes me doubt the success rate MAZE mentioned in the Medscape article.
CardioNP
Jan-
Not all surgical "MAZE" procedures are created equal. Just as there are many different catheter-based techniques to perform afib ablations (as outlined in this article), there are many different techniques for performing surgical (open chest) MAZE procedures. The best results have been historically with the full "cut and sew" method originally described by Jimmy Cox and colleagues, but the time and effort involved has been supplanted by cryotherapy (freezing) and radiofrequency energy lesions that are not always successful in acheiving full isolation of pulmonary veins and hence subject to recurrence just like the catheter-based techniques. Unfortunately, the surgical literature success rates are also influenced (negatively) by the procedure often being performed in much "sicker" patient population (associated valvular heart disease, coronary disease and the like), so comparison with the catheter ablation cases (typically with more "normal" atria) is impossible.
I recently published an article on AEDs – here is a quote from it, in case you are interested:
Statistics give us more and more pieces of information that are bound to worry us, to make us react and change something if we can. More and more people and in earlier and earlier stages of their life die of a heart disease. Statistics, only in the US, are extremely alarming:
- Every 30 seconds someone dies because of a heart disease;
- More than 2.500 Americans die daily because of heart diseases;
- Every 20 seconds there is a person dying from a heart attack;
- Each year 6 million people are hospitalized because of a heart disease;
- The number 1 killer is a heart disease.
Although AEDs are not a universal panacea for all heart diseases, nothing else can compete to its major feature, that of actually re-starting the heart after it has been stopped by a sudden cardiac arrest. Under these circumstances is it necessary to ask you why anyone in this world, any family, in any home would hope for having such a device in their first aid locker?
If you feel this help, please drop by my website for additional information, such as Public Access Defibrillatio PAD or additional resources on AED manufacturers such as Philips defibrillators, Zoll AEDs or Cardiac Science AEDs.
Regards,
Michael
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