Surgery 'superior' to drugs for paroxysmal AF group

Catheter ablation is more effective than medicines for patients with paroxysmal AF, a US study suggests.

Catheterisation: more effective than drugs for some, say researchers
Catheterisation: more effective than drugs for some, say researchers

The study reflects the increasing specialisation of AF therapy, according to Dr Terry McCormack, a GP in Whitby, North Yorkshire and former chairman of the Primary Care Cardiovascular Society.

But catheter ablation would only be suitable for a limited subset of patients needing AF therapy, he added.

'AF treatment by catheter ablation in the UK refers to a select group of patients - mainly young and symptomatic patients who need specialist care by a cardioelectrophysiologist rather than a GP or even regular cardiologist,' he said.

For the latest study, researchers compared catheter ablation with drug therapy for patients with paroxysmal AF who had failed to respond to previous treatment with at least one antiarrhythmic drug.

After nine months, 66 per cent of patients in the catheter ablation group remained free from symptomatic paroxysmal AF compared with 16 per cent of patients given drug therapy.

In addition, 70 per cent of patients in the catheter group were free from symptomatic recurrent AF, compared with 19 per cent of patients treated with drug therapy.

Lead researcher, Dr David Wilber of Loyola University Medical Center, Illinois, said the trial demonstrated the superiority of catheter ablation over drug therapy for patients with paroxysmal AF who did not respond to one or more drugs.

'Catheter ablation provided significantly better rhythm control and improved quality of life with a favourable safety profile,' he said.

Unsuccessful drug therapy has previously been shown to predict failure of subsequent attempts at using medication to control rhythm.

'These findings argue for early use of catheter ablation therapy in patients with paroxysmal AF unresponsive to initial attempts with pharmacological control,' the authors conclude.

During the course of the study, major treatment-related adverse events occurred in five of the 57 patients (8.8 per cent) treated with pharmacotherapy. Such events occurred in five of the 103 patients (4.9 per cent) treated with catheter ablation.

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