A procedure that destroys part of the cardiac tissue responsible for the most common type of heart rhythm disorder is more effective than drug therapy at keeping the erratic rate in check, a study found.
The results presented at the Heart Rhythm Society meeting in Boston suggest the approach known as cardiac ablation should be considered as an initial treatment for atrial fibrillation, said lead researcher Carlos Morillo from Hamilton Health Sciences-McMaster University in Canada. It’s now used for patients who don’t benefit from standard drug therapy, he said.
The study followed 127 patients with paroxysmal atrial fibrillation, where the heart’s two upper chambers beat out of synch with the bottom chambers in bouts that typically resolve on their own. After two years, 52 percent of patients getting the ablation procedure had a recurrence, compared with 72 percent of those on drugs. Side effects were also less common with ablation, Morillo said in a telephone interview.
“The patients that received the ablation had a marked reduction in atrial fibrillation,” he said. “It’s definitely superior to antiarrhythmic drugs. This study supports the notion that the earlier you intervene with ablation that’s superior, the better the result.”
Drug therapy will continue to be necessary for many patients because of the recurrences, Morillo said. The study drugs included Sanofi (SAN)’s Multaq and older medicines that are now available in generic forms, including amiodarone, flecainide and propafenone.
More than 2.6 million Americans have atrial fibrillation, and the number is expected to soar to 12 million by 2050, according to the Centers for Disease Control and Prevention in Atlanta. The condition can cause chronic fatigue and shortness of breath, and may make patients more vulnerable to heart failure and stroke.
While the results show ablation is more beneficial than drug therapy, it does carry rare and deadly risks, said Hugh Calkins, director of electrophysiology of Johns Hopkins Medicine at the university in Baltimore. Drug therapy is easy to give and it’s generally clear within a couple of weeks if it will work, he said.
Ablation techniques and tools are improving, said Calkins, the president-elect of the Heart Rhythm Society, in a telephone interview.
“I don’t think one small study is enough to suggest catheter ablation should be performed before drug therapy in all patients,” he said. “Patient preference is key.”
The study was funded by Johnson & Johnson (JNJ:US)’s Biosense Webster division, which sells catheters used to treat atrial fibrillation. The ablation catheters or devices used with them are also sold by companies including St. Jude Medical Inc., Medtronic Inc. (MDT:US) and Boston Scientific Corp. (BSX:US)
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