Should You Get Pills or Surgery for A-Fib?

By | March 17, 2019

As Epstein explained, during ablation, “long catheters — wires with electrodes on them — are placed into the heart via the large veins in the groin. Radio waves are delivered from the catheter to the heart muscle, which causes heat and the controlled destruction of the muscle cells responsible for causing atrial fibrillation.”

Sometimes ablation is performed using tiny balloons that freeze the heart muscle to create the same effect.

Of course, no treatment is foolproof. “Depending on the patient the procedure can be as effective as 80-90 percent,” Epstein said, “but in others, at best, 50 percent.”

Many other patients get drug therapy alone to control the aberrant heart rhythm. But Epstein said outcomes are often “disappointing because the drugs do not work that well and that they can cause ‘pro-arrhythmia.’

“Pro-arrhythmia is when a drug used to treat an abnormal heart rhythm can actually cause a worse, more dangerous heart rhythm,” he explained.

Long-term benefits

To settle the meds-versus-ablation debate, the NHLBI helped conduct these two trials, which included more than 2,200 patients treated at 126 sites in the United States, Canada, Asia and Europe.

Half the patients had ablation and half were put on drug therapy, but could have ablation if their a-fib symptoms could not be controlled with medication — something known as “intent to treat.”

In the end, about 27 percent of the patients who started on drug therapy did end up undergoing ablation.

The median follow-up of patients in the trial was about four years.

“While data from the trial did not show that ablation was superior to drug therapy in reducing rates of deaths and strokes, it showed reduced recurrence of atrial fibrillation, as well as reductions in hospitalizations,” Rosenberg said in the news release.

The researchers noted that the overall rate of deaths and strokes was lower than expected. Also, about 9 percent of the patients assigned to receive ablation did not, in the end, undergo the procedure.

So, “when we examined the data according to the treatment actually received, the ablation group had significantly lower rates of death as well as the combination of death, disabling stroke, serious bleeding, or cardiac arrest compared with patients who only received drug therapy,” said study principal investigator Dr. Douglas Packer. He’s a cardiologist and professor of medicine at Mayo Clinic in Rochester, Minn.

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