Global atrial fibrillation study finds simple ablation has best outcomes

Medical Xpress / Tulane University / JAMA ^ | June 21, 2022 | Dr. Nassir Marrouche et al

[ConservativeMind]

Results from one of the largest global studies of atrial fibrillation (AFib) procedures show that the simple approach is usually best when it comes to ablation, a procedure where physicians destroy or ablate cardiac tissue to correct irregular heart rhythms.

Researchers found that using advanced image-guided technology to more aggressively target diseased areas of the heart that cause arrythmias didn't lead to better outcomes for patients.

"Simplicity is key. Don't ablate too much, especially at advanced stages," said lead author Dr. Nassir Marrouche. "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."

Half of the patients received standard care—pulmonary vein isolation (PVI) treatment where doctors ablate areas in the left upper chamber of the heart where the four lung veins meet.

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.

Researchers found no significant difference in arrhythmia recurrence between the two groups. However, the group that received the more aggressive treatment experienced a higher rate of poor safety outcomes with six patients (1.5%) suffering a stroke.

Marrouche said that the study shows that AFib patients with extensive fibrosis have too much scarring for aggressive ablative therapy to be effective using conventional tools. Researchers also suspect that it is not only the extent of fibrosis that played a role in the study outcomes. In evaluating hundreds of procedures by the world's leading electrophysiologists, they discovered that there is little uniformity in how doctors perform ablation interventions, which may also contribute to disparate outcomes, Marrouche said.

[ConservativeMind]

I would have thought MRI would have helped, and, in theory, it still could, but it seems it is encouraging over ablation.

[ConservativeMind]

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[C210N]

Ablation to tissue, is this anything like leeches to blood?

[Puppage]

I have absolutely NO IDEA what the title of this thread means. :-)

[eastexsteve]

It’s the most common cardiac condition. I have it, although I haven’t had a full blown episode in over 10 years. But, every great now and then, I have a few seconds of irregular rhythm. My doctor still keeps me on the atenolol.

[ConservativeMind]

The admin moderator won't let me add longer descriptions to the title. I have to wait until Jim comes back, it seems.

Basically, you have a heart that isn't beating right and the better treatment is to burn off a layer of muscle from the inside of your heart. The normal way gets less muscle off than with MRIs. Getting extra muscle burned off is now found to be problematic.

[libertylover]

I have absolutely NO IDEA what the title of this thread means. :-)

Lucky you.

[Right_in_Virginia]

Bkmk