The results from one of the largest global studies of atrial fibrillation (AFib) procedures show that the simplest approach is usually best when it comes to ablation, a procedure where physicians destroy or ablate cardiac tissue to correct irregular heart rhythms. The findings could change the way patients are treated for AFib.
Researchers from Tulane University and partner institutions found that using advanced image-guided technology to more aggressively target diseased areas that cause arrhythmias did not lead to better outcomes for patients – and put some at higher risk of strokes, according to results. of the DECAAF II trial published in JAMAGeneral Chat Chat Lounge
“Simplicity is key. Don’t ablate too much, especially at advanced stages,” said lead study author Dr. Nassir Marrouche, Director of the Tulane Heart and Vascular Institute and the Research Innovation for Arrhythmia Discoveries (TRIAD) at Tulane University School of Medicine. “Too much ablation is not helping our patients today. It is putting them at higher risk. This is a practice-changing finding from our study.”
AFib occurs when the upper and lower chambers of the heart are out of sync, causing the heart to beat irregularly. It affects more than 2.7 million Americans and is a leading risk factor for strokes. When AFib cannot be controlled by medication, doctors perform a procedure to ablate fibrotic or diseased areas of the heart with heat or cold to create a scar that disrupts the electrical signal that causes arrhythmia.
For the study, researchers followed 843 AFib patients undergoing ablation treatment at 44 hospitals in 10 countries, including the United States, Germany, France and Australia. All patients received magnetic resonance imaging (MRI) scans to quantify the amount of diseased tissue within their hearts. (Those with a higher percentage of diseased tissue are at higher risk for arrythmia relapse, according to findings from the original DECAAF trial.)
Half of the patients received standard care – pulmonary vein isolation (PVI) treatment where doctors met the left lung in the ablate area where the four lung veins met.
For the other group, doctors used the MRI scans to create a detailed 3D map of all diseased areas along the left atrium of the heart. They performed conventional PVI treatment and then used the digital map to ablate diseased tissue more aggressively and precisely outside of conventional treatment areas.
All of the study patients received smartphone EKG devices to monitor their heart rhythms daily after treatment, and researchers followed up with them at 3-, 6- and 12-month intervals.
Researchers found no significant difference in arrhythmia recurrence between the two groups. However, the group that received more aggressive treatment experienced a higher rate of poor safety outcomes with six patients (1.5%) suffering a stroke.
Marrouche said the study shows that AFib patients with extensive fibrosis have too much scarring to be effective tools for effective ablative therapy. Researchers also suspect that it is not just the circumstance of fibrosis that played a role in the study results. In evaluating hundreds of procedures by leading electrophysiologists around the world, they discovered that there is little uniformity in how doctors perform ablation interventions, which may also contribute to disparate outcomes, Marrouche said.
“Atrial fibrillation procedures have become very complex over the years. We are ablating hundreds of thousands of people a year now, and we are striving to do more and more ablation for the population with persistent or persistent AFib,” Marrouche said. “But our study shows that it is not necessary, especially for those with more myopathy. Simple ablations can effectively treat these patients instead of going to widespread ablation to treat fibrotic areas that we struggle to control.”
Materials provided by Tulane UniversityGeneral Chat Chat Lounge Note: Content may be edited for style and length.
General Chat Chat Lounge