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Atrial fibrillation: Drugs or ablation?
September 01, 2009Atrial fibrillation ablation is one of the fastest growing techniques in cardiology and due to the very high number of patients that might be candidates to this procedure, a significant number of resources will have to be devoted to it to be able to treat them in the following years.
Atrial Fibrillation (AF) is the most frequent cardiac arrhythmia. Its prevalence increases with age affecting more than 5% of the population older than 75 years of age. Overall it is estimated that more than 3.000.000 patients in Europe suffer from atrial fibrillation. Atrial fibrillation doubles the possibility of death mainly due to the higher incidence of thromboembolic events and occurrence of heart failure in patients suffering this arrhythmia.
One treatment objective is directed to avoid the negative consequences of the arrhythmia by trying to maintain normal sinus rhythm. Two strategies exist to obtain this result:
1. Chronic treatment with antiarrhythmic drugs (AAD)
2. Catheter ablation of atrial fibrillation
1. AAD treatment tries to block or modulate the electrical activity of the heart avoiding initiation and perpetuation of the arrhythmia. It is effective in about 60% of patients and requires long-term treatment. Many of the drugs used have side effects, some of them disabling for the patient. Many drugs are available and combination of them might be used in case of failure. Compliance of the treatment is basic for long-term success.
2. Catheter ablation has emerged as an alternative to obtain stable sinus rhythm in this population. It has been demonstrated that a significant number of AFepisodes initiate in the area of the pulmonary veins located in the left atrium. Using one or several catheters inserted through the femoral veins, they are inserted into the heart and brought to the left atrium through a transseptal approach. Once in the left atrium energy (radiofrequency, cold) is delivered in different areas (mainly around the pulmonary veins) to create lesions that block the electrical activity responsible for the arrhythmia. The effectiveness of this technique is around 70% and in about 25% a second procedure is needed to finish the ablation lines. As any invasive procedure some major complications may occur like cardiac tamponade (1%), thromboembolic events (0.5%) or atrio-esophageal fistula (1/1000). In case of success the patient does not requires continuation with AAD and the arrhythmia is cured.
The decision of which treatment to be used will have to be based on a number of considerations: type of patient, willingness of the patient, experience of the centre in ablative techniques, etc.
It is estimated than more than 10.000 atrial fibrillation ablation procedures are performed annually in Europe and the number is increasing exponentially since over the last years availability of more sophisticated techniques and equipment has produced a marked increase in the number of centres performing atrial fibrillation ablation. Three dimensional mapping systems, robotic techniques, new energy sources and new and more reliable catheters are easing the procedure and improving efficacy and safety.
European Society of Cardiology
1. Chronic treatment with antiarrhythmic drugs (AAD)
2. Catheter ablation of atrial fibrillation
1. AAD treatment tries to block or modulate the electrical activity of the heart avoiding initiation and perpetuation of the arrhythmia. It is effective in about 60% of patients and requires long-term treatment. Many of the drugs used have side effects, some of them disabling for the patient. Many drugs are available and combination of them might be used in case of failure. Compliance of the treatment is basic for long-term success.
2. Catheter ablation has emerged as an alternative to obtain stable sinus rhythm in this population. It has been demonstrated that a significant number of AFepisodes initiate in the area of the pulmonary veins located in the left atrium. Using one or several catheters inserted through the femoral veins, they are inserted into the heart and brought to the left atrium through a transseptal approach. Once in the left atrium energy (radiofrequency, cold) is delivered in different areas (mainly around the pulmonary veins) to create lesions that block the electrical activity responsible for the arrhythmia. The effectiveness of this technique is around 70% and in about 25% a second procedure is needed to finish the ablation lines. As any invasive procedure some major complications may occur like cardiac tamponade (1%), thromboembolic events (0.5%) or atrio-esophageal fistula (1/1000). In case of success the patient does not requires continuation with AAD and the arrhythmia is cured.
The decision of which treatment to be used will have to be based on a number of considerations: type of patient, willingness of the patient, experience of the centre in ablative techniques, etc.
It is estimated than more than 10.000 atrial fibrillation ablation procedures are performed annually in Europe and the number is increasing exponentially since over the last years availability of more sophisticated techniques and equipment has produced a marked increase in the number of centres performing atrial fibrillation ablation. Three dimensional mapping systems, robotic techniques, new energy sources and new and more reliable catheters are easing the procedure and improving efficacy and safety.
European Society of Cardiology
Atrial Fibrillation Current Events and Atrial Fibrillation News RSSSize matters: Obesity leading risk factor of left atrial enlargement during aging
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Experts unveil new CVD guidelines and position papers
Several new guidelines and position papers offering the most up to date information to ensure that clinicians practice evidence-based medicine were released at the Canadian Cardiovascular Congress 2009 this week.
Learning the risks for stroke - and taking action
With this theme in mind, the European Society of Cardiology (ESC) emphasises that most of the risks for stroke are also the major risks for coronary heart disease - and thus the object of the ESC's far-reaching prevention programme.
Afib triggered by a cell that resembles a pigment-producing skin cell
The source and mechanisms underlying the abnormal heart beats that initiate atrial fibrillation (Afib), the most common type of abnormal heart beat, have not been well determined.
New blood-thinning drug safer than rat poison
In an article reviewed by F1000 Medicine Faculty Members Robert Ruff, Brian Olshansky and Luis Ruilope, the blood-thinner dabigatran is shown to protect against stroke, blood clotting and major bleeding as effectively as warfarin, but with fewer side effects.
Women with diabetes at increased risk for irregular heart rhythm
Diabetes increases by 26 percent the likelihood that women will develop atrial fibrillation (AF), a potentially dangerous irregular heart rhythm that can lead to stroke, heart failure, and chronic fatigue.
Women with Atrial Fibrillation Are at Significantly Higher Risk of Stroke and Death Compared to Men and Receive Less Attention
Even though the incidence of atrial fibrillation is higher in men than women, a review of past studies and medical literature completed by cardiac experts at Rush University Medical Center shows that women are more likely than men to experience symptomatic attacks, a higher frequency of recurrences, and significantly higher heart rates during atrial fibrillation, which increases the risk of stroke.
Mount Sinai first in nation to ablate atrial fibrillation using new visually-guided balloon catheter
Physicians at The Mount Sinai Medical Center in New York became the first in the U.S. to ablate atrial fibrillation using a visually-guided laser balloon catheter.
Irbesartan reduces heart failure in patients with quivering heart
Most research in atrial fibrillation (AF) has focused on reducing stroke and other embolic events. Yet heart failure occurs more frequently in AF patients, but has not been the focus of intervention research.
Results from the European CRT survey
The European cardiac resynchronization therapy (CRT) Survey is a joint initiative taken by the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA) of the European Society of Cardiology.
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Atrial Fibrillation - The Most Common Arrhythmia (Have A Heart Series) Starring: Dr. Gerry Maddoux Directed By: Mark Baer Also With: Dr. Gerry Maddoux (Writer), Mark Baer (Producer) | |
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A Practical Approach To Catheter Ablation Of Atrial Fibrillation by Lippincott Williams & Wilkins A Practical Approach to Catheter Ablation of Atrial Fibrillation : A Practical Approach to Catheter Ablation of Atrial Fibrillation Pub Date: April 2008 Product Type: Print Author/s: Hugh Calkins MD; Pierre Jais MD; Jonathan S Steinberg MD Written and edited by expert electrophysiologists, this book is a practical, well-illustrated guide to the most successful techniques for catheter ablation of atrial fibrillation. While other texts address ablation of different arrhythmias, this is the first book to focus specifically on atrial fibrillation.Chapters explain how to establish programs and laboratories for treating atrial fibrillation; use complex imaging modalities and guidance systems; implement a variety of catheter-based ablation strategies, either isolated or in... |
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