Is Ablation Rx the Best First Choice for A-Fib?

By Amy Norton HealthDay Reporter

TUESDAY, November 17, 2020 (HealthDay News) – A procedure that freezes pieces of heart tissue may be a better option than medication for people with atrial fibrillation (a-fib or AF), two clinical trials have revealed.

A-fib is a common cardiac arrhythmia in which the upper chambers of the organ (the atria) beat erratically. Although it is not immediately life threatening, over time it can lead to complications such as heart failure or blood clots that lead to a stroke.

Right now, the standard first-line treatment is medication, said Dr Jason Andrade, lead investigator in one of the new studies.

These drugs help control the rate and rhythm of the heart. If they don’t, patients can switch to another option called ablation. It’s a minimally invasive procedure in which doctors use heat or cold to destroy the pieces of heart tissue that generate the faulty electrical signal that causes the arrhythmia.

The two new trials challenged the idea that ablation should only be a second option.

“The drug approach is largely treating a symptom,” said Andrade, who heads the atrial fibrillation clinic at Vancouver General Hospital in British Columbia, Canada. “If we start with an ablation, we may be able to resolve atrial fibrillation early in its course, which potentially means reducing the risk of stroke and other heart problems down the road.”

His team found that ablation was, in fact, a better first-line treatment.

The A-fib patients who underwent ablation were half as likely to have an arrhythmia episode the following year as those on treatment. And they were 61% less likely to have a symptom-causing episode.

The results were published simultaneously on November 16 in the New England Journal of Medicine and reported at an American Heart Association online meeting.

“Ablation is more effective than drugs for AF, even if none are 100%,” said Dr. Nieca Goldberg, spokesperson for AHA and cardiologist at NYU Langone Health in New York.

She noted that longer-term results are still needed, since the patients in the trials were only followed for one year. “But I don’t think the drugs will become more effective over time,” Goldberg added.

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