Procedure Can Fix Heart Rhythm

Burning a bit of heart tissue can help to stop one type of abnormal rhythm, a study found. The study evaluated a treatment for atrial fibrillation. In this type of heart rhythm, the upper chambers quiver rather than beat normally.

The study included 167 people who had not been helped by drug treatment. Most received catheter ablation. This treatment uses radiofrequency energy to destroy the small section of heart tissue that causes the abnormal rhythm. Other patients were given a drug they had not tried before. About 66% of those who had catheter ablation returned to a normal heart rhythm within 9 months. Only 16% of those on a new drug regime had this result. The difference was so large that researchers stopped the study early.

The study was in the Journal of the American Medical Association on January 26.

What Is the Doctor's Reaction?

Atrial fibrillation is a common condition. It occurs when the upper part of the heart (called the atrium) beats fast and in an irregular rhythm.

This condition can be serious because blood clots may form in the quivering atrium. These blood clots can travel to the brain, causing a stroke. Treatment includes blood thinners to prevent clots from forming. Medicines also can be given to encourage a normal, regular heart rhythm.

But there are other ways to get the heart beating regularly. Some atrial fibrillation is continuous, rather than occurring from time to time. In these cases, a small electrical current applied to the chest can often "reset" the heart's rhythm back to normal. Or, doctors can apply electrical current directly to heart's lining. This is done through a small tube (called a catheter) inserted into the heart. The current damages a tiny portion of the inside of the heart. This interrupts the electrical signals that cause atrial fibrillation.

This procedure, called "catheter ablation," is the subject of a newly published study. The results could change how atrial fibrillation is treated.

The new study compared medicine to catheter ablation in the treatment of "paroxysmal" atrial fibrillation. In these cases, the abnormal rhythm occurs only from time to time. Here's what the study found:

• Heart rhythm returned to normal for about two-thirds of patients after catheter ablation treatment. Only one-fifth of those receiving medicines had similar success.


• People in the catheter ablation group were less likely to have symptoms such as palpitations or lightheadedness. When symptoms occurred, they were less severe.


• Major side effects were nearly twice as common in the group receiving drugs (8.8%) as in the catheter ablation group (4.9%).

Does this mean doctors should stop treating atrial fibrillation with medicines? Should they rely solely on catheter ablation? In my view, the answer is "not yet." Because of how the study was done, it's too early to abandon medicine treatment of atrial fibrillation. For example:

• Everyone in the study had taken at least one medicine, with no improvement. People who were helped by medicine were not included.


• Everyone in the study had at least three episodes of atrial fibrillation within six months. It's possible that those who had this problem less often might have done better with medicine than with catheter ablation.


• Researchers kept track of people for only nine months. It's possible that over the long term, catheter ablation is no better than drug treatment for control of rhythm or symptoms.

This study also did not address how easily people would accept the idea of catheter ablation. To enroll in this study, everyone had to agree to the possibility of having this procedure. In "real life," people may prefer medicines, even if their success rate is lower.

Still, we need to see if the findings of this study are confirmed and extended long-term. If so, the research could lead to a major change in how doctors treat atrial fibrillation.

What Changes Can I Make Now?

Know the factors that increase the risk of atrial fibrillation. They include:

• A history of rheumatic heart disease (rheumatic fever that affected the heart and its valves)


• Heart and artery disease (such as angina or past heart attack)


• Diabetes


• High blood pressure


• Excessive alcohol intake


• An overactive thyroid


• Advanced age

You can make changes now to modify these risk factors. These changes could reduce your risk of atrial fibrillation. For example, treating high blood pressure could lower the chances you’ll develop atrial fibrillation. So could drinking less alcohol. Aim for no more than two drinks per day for men, or one drink per day for women.

See your doctor if you have symptoms of atrial fibrillation. They include:

• Palpitations (a feeling that the heart is racing, beating abnormally, or more forcefully than usual)


• Shortness of breath


• Chest discomfort


• Dizziness, lightheadedness or fainting


• Fatigue

If you are diagnosed with atrial fibrillation, review all of your treatment options with your doctor. Catheter ablation may become a more popular option in the future. However, it's unlikely that any one type of treatment will be best for everyone. Several factors may affect your decision. They include:

• Your other medical problems


• Other medicines you take


• Your own preferences

What Can I Expect Looking to the Future?

Having new and effective treatment options is clearly a good thing. The challenge is knowing when to use them. You can expect to hear much more about the research that compares older treatments with new technologies for common medical problems. Catheter ablation for atrial fibrillation is just the latest example.