AF Ablation
Go slowly; look for causes; treat these causes; give peace a chance. There is almost always a fix for AF. It’s rarely with a catheter alone - John Mandrola MD
image by: Get Smart About AFib
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A cautionary note on AF ablation
It’s time to write an update on AF ablation. Things have changed.
The major change is that I am doing many fewer ablations for AF.
The reason is we have a better understanding of the disease, or should I say, condition? In the last 2-3 years, good science has changed the way specialists see AF. The old-thinking had AF in its own silo. Your ECG showed AF so you had the disease AF. And if you had a disease, we had a fix–say drugs or ablation.
My partners would say, “John, we are sending you this patient with AF; please fix him.” And by fix, they meant drugs or ablation. Like a blockage–make it go away.
That’s not how AF treatment works. I’m surprised it…
Resources
Ablation for atrial fibrillation
Why and when should you consider undergoing an ablation procedure — and how well does it work?
What is a Cardiac Ablation Procedure?
Cardiac ablation is a minimally-invasive procedure that involves inserting catheters into your blood vessel and threading wires up into your heart. Your doctor will then use catheters with tiny electrodes attached to the end to destroy (ablate) small areas of your heart tissue that aren’t using electrical signals correctly.
Answering the critics of atrial fibrillation ablation
In the gratifying category, few things rank higher than vanquishing atrial fibrillation with catheter ablation. But yet, not everyone thinks so highly of a procedure that has come to dominate my medical career.
Catheter ablation for atrial fibrillation: who, why and does it work?
Until results of current long-term studies become available, ablation will continue to be reserved predominantly for patients with drug-refractory, symptomatic AF.
Mark Patinkin: It was only a little shortness of breath ... or was it?
As they slid me onto the central operating table, Dr. Nikhil Panda walked in. He would be performing the procedure — a cardiac ablation — threading probes into my heart, pushing a needle through its central wall, then burning off spots that were short-circuiting to scar them over. If there was a crisis, like excessive bleeding, they would need to saw me open. That’s rare but it was the last risk I was warned of.
AF ablation and the hard truths about AF
One of the most important AF studies of our time was (or is) the Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial. CABANA is an ongoing multicenter, international study that compares anti-arrhythmic drugs to catheter ablation... The CABANA trial is doomed to fail. Not because it’s a bad trial or bad idea or done by bad investigators. It’s none of that. The problems with CABANA are the following realities...
CABANA: No Outcomes Benefit In First Big Trial Of AF Ablation
Catheter ablation for atrial fibrillation (AF) produced no significant improvement in clinical outcomes in a large and important new clinical trial. CABANA is the first and long-anticipated randomized controlled trial of AF ablation in the more-than-two-decadelong history of the procedure.
Catheter Ablation Versus Antiarrhythmic Drug Therapy for AF (CABANA) Trial
The CABANA trial illustrated that compared with antiarrhythmic drug therapy, catheter ablation did not significantly reduce the primary composite endpoint of death, disabling stroke, serious bleeding, or cardiac arrest in patients with AF. However, the trial confirmed that patients who get the procedure experience much greater symptom relief and significantly improved quality of life at 1 year without increasing complications than those who get only drugs.
Don’t Put That in My Heart Until You’re Sure It Really Works
Many have touted catheter ablation, which can cost well above $20,000, as a “cure” for atrial fibrillation. Yet a new randomized controlled trial, the gold standard of clinical research, has produced disappointing results. The study, called the Cabana trial, found that the procedure was no more effective than much cheaper medications at reducing mortality, cardiac arrest, major bleeding and stroke.
Heart Device Procedure Is No Better Than Drug Therapy for Irregular Heartbeat: Study
An increasingly common cardiovascular procedure using a device made by several medical technology companies was no better than drug therapy at preventing deaths, strokes and certain other complications, a new study found. The outcome of the trial raises questions about the procedure, known as catheter ablation, to treat patients with atrial fibrillation.
Impact of Catheter Ablation on Long-Term Outcomes in Patients With Atrial Fibrillation: A Meta-Analysis
In the current meta-analysis, catheter-based AF ablation was associated with decreased risk of all-cause mortality, stroke, and hospitalization due to heart failure. However, no significant difference was reported in terms of major bleeding events. Only observational studies have shown a decrease in the risk of stroke.
Should we recommend catheter ablation to all patients with persistent atrial fibrillation?
To summarise, this Cochrane review asks an important question on ablation compared to medication in persistent AF, but published RCT data on this subject is surprisingly sparse. As a result, it is not possible to conclude that catheter ablation techniques are superior to medication in patients with non-paroxysmal AF. Therapy should always be tailored to individual patients. In patients with persistent AF, this will usually mean an initial trial of medication followed by possible invasive assessments and/or ablation only when symptom control has not been achieved.
A cautionary note on AF ablation
It’s time to write an update on AF ablation. Things have changed. The major change is that I am doing many fewer ablations for AF. The reason is we have a better understanding of the disease, or should I say, condition? In the last 2-3 years, good science has changed the way specialists see AF. The old-thinking had AF in its own silo. Your ECG showed AF so you had the disease AF. And if you had a disease, we had a fix–say drugs or ablation.
AF-Ablation
A helpful tool for the patient to recognize the AF symptoms, to understand what ablation is and to guide him through the diagnostic pathways and treatment options.
Get Smart About AFib
The goal of Get Smart About AFib is to raise awareness of Atrial Fibrillation (AFib) signs, symptoms and treatment options and encourage patients to seek treatment as soon as possible.
StopAfib.org
Like other atrial fibrillation treatments, it is most successful in treating paroxysmal atrial fibrillation, but much progress has been made in treating persistent and longstanding persistent atrial fibrillation as well.
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