Saturday, August 26, 2006

Atrial Fibrillation Ablation Update

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.



CardioNP said...

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.


DrWes said...

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.