Archief Roodbont

Catheter ablation shows promise in halting AF progression

7 November 2008

MedWire News: Early catheter ablation may be more effective than antiarrhythmic drug therapy for preventing atrial fibrillation (AF) recurrence and delaying disease progression, a 5-year follow-up study has shown.

The research, which appears in the journal Heart Rhythm, also found that older age, diabetes, and heart failure are independent predictors of AF progression.

For the study, Carlo Pappone and colleagues at San Raffaele University Hospital in Milan, Italy, recruited 106 patients with a first AF occurrence and monitored them for 5 years.

At baseline, the patients’ mean age was 57.5 years and 68% were male; 54 patients had lone AF and 52 had comorbidities; and 56 had paroxysmal AF, 24 had persistent AF, and 16 had permanent AF.

During follow-up, 56 patients had recurrent AF episodes occurring, on average, 19 months after the initial episode. These patients were all initially treated with conventional antiarrhythmic drugs; nevertheless AF became persistent in 24 of 45 patients who continued on long-term drug therapy.

A total of 11 patients underwent catheter ablation due to refractoriness or intolerance to antiarrhythmic drugs. No AF recurrences or AF progression occurred after ablation, report Pappone et al.

The main determinants of AF progression were comorbidities and catheter ablation, which increased and decreased the risk for progression, respectively.

Finally, older age, diabetes, and heart failure were all significant independent risk factors for the progression to permanent AF. This finding “indicates a significant role of underlying heart disease in modulating AF progression,” the authors say.

They conclude: “Catheter ablation may be of benefit in preventing AF recurrences and delaying final AF progression, but larger randomized studies are required to confirm this preliminary experience.”

In an accompanying editorial, Hugh Calkins (Johns Hopkins Hospital, Baltimore, Maryland, USA) described the study as “welcome and timely” and “unique for many reasons.”

“The glimmer of hope in this study is that the 11 patients who underwent catheter ablation all had an excellent response with no recurrent AF and no progression during follow-up,” he wrote.

“The results of this study need to be confirmed in much larger multicenter clinical trials. Only then can prevention of progression of AF be considered an appropriate indication for catheter ablation of AF.”

Heart Rhythm 2008; 5: 1501–1507