Radiofrequency Catheter Ablation May Decrease Atrial Fibrillation Stroke Risk and Heart-Failure Events
April 27, 2011
- Summary: This article explores the decrease in stroke risk, TIAs, and heart-failure events associated with radiofrequency catheter ablation for atrial fibrillation.
- Reading time is approximately 2-3 minutes
In our recent video interview with Dr. Matthew Reynolds of the Harvard Clinical Research Institute, he mentioned his current research that might give patients information to help them make better decisions about their treatment options and help ensure that insurance companies will pay for treatment. That research was just presented at the recent American College of Cardiology Scientific Sessions.
In this study, which was underwritten by Biosense Webster, Dr. Reynolds and colleagues accessed data from claims databases (hospitals, insurance companies, Medicare, etc.) and separated out atrial fibrillation patients. They created 801 matched pairs of afib patients with similar characteristics where one had received a radiofrequency catheter ablation and the other was on anti-arrhythmic medication and did not have an ablation. The intent was to analyze these patient pairs for incidence of strokes, TIAs (transient ischemic attacks, called mini-strokes), and heart failure events.
Having an ablation was found to result in a 40% decrease in the risk of stroke and a 37% decrease (non-significant) in heart failure events when comparing those who had ablations with those who did not.
Interestingly, 40% of ablation patients were still on anti-arrhythmic drugs after three years as compared to 60% of those who did not get ablations. And warfarin use, which had been 70% at the start for both groups, was 50% at three years for both. Whether or not this was appropriate based on risk factors is unknown.
To learn more about this study, and watch the previous video interview with Dr. Reynolds, see:
- Dr. Matthew Reynolds Discusses Quality of Life After Atrial Fibrillation Catheter Ablation — Video
- Lower risk of stroke/TIA among AF patients treated with ablation: Retrospective analysis
- ACC: RF Ablation May Cut Stroke Risk in Afib
Comments:
That 40% of ablation patients were still on anti-arrhythmic drugs after three years seems somewhat surprising as you would expect those who had successful ablations to have been weaned off anti-arrhythmic drugs within a few months of the procedure. This may be due to a lack of follow up and monitoring by the treating physician, or a disconnect due to handoffs to other doctors, or simply that the afib may not have been successfully eradicated. However, afib appears to have been reduced enough to significantly impact stroke risk.
With half of each group still taking warfarin after an ablation, this doesn’t answer one of the hottest issues—should those who have had catheter ablations remain on warfarin beyond three months after the procedure.
Whether or not catheter ablation can reduce an afib patient’s stroke risk is something that we are anxious to find out, though it seems intuitive enough. If you’re not having afib, then clots are less likely to form and the fibrosis that can result in strokes would be less likely to build up. Thus this study gives us a peek at what results we may expect to see from the CABANA trial when it is complete in 2015.
These results, showing decreased stroke risk, would likely apply to other types of ablation, and surgery as well, since they also decrease the amount of afib.
Disclaimer: The company mentioned in the article is not a StopAfib.org donor at the time that this is being published.