Ablation stopped atrial fibrillation in 81% of patients in new study

Radio frequency (RF) ablation is the most common treatment for atrial fibrillation (AFib), an irregular and usually fast heartbeat.

Research shows that this procedure is safe and effective, but clinicians have refined RF ablation over the years to improve its safety and effectiveness.

Despite its widespread use, few studies have examined how modifications and improvements in RF ablation techniques affect its effectiveness.

A recent study published in the journal Heart Rhythm examined the success of RF ablation in several large hospitals in the United States. The researchers found that one year after RF ablation, 81.6% of patients were free of atrial fibrillation. Of these patients, 89.7% were able to stop taking medications to treat this condition.

These rates are higher than those achieved in clinical trials, indicating that the modifications did improve safety and effectiveness.

Atrial fibrillation and RF ablation

Atrial fibrillation (AFib) is the most common form of arrhythmia - a heart rhythm disorder. In Australia, the United States and Europe, it affects 1–4% of the population and is particularly common among older people.

By interfering with blood flow, causing palpitations, shortness of breath and chest pain, AFib increases the risk of other problems.

Dr. Paul Drury, a board-certified cardiologist who was not involved in the study, noted:

"Atrial fibrillation, although not considered a life-threatening condition, is a serious health problem, increasing the lifetime risk of stroke and congestive heart failurein the patient. It often requires lifelong monitoring and treatment."

Drury is associate medical director of electrophysiology at MemorialCare Saddleback Medical Center in Laguna Hills, California.

RF ablation is a common treatment tool for AFib. It uses heat to destroy the areas of heart tissue that cause this condition. The technique has been used for many years, most often to treat problems with the gastrointestinal tract.

Re-evaluating RF ablation for the treatment of AFib

Early randomized controlled clinical trials showed that early versions of RF ablation had good safety and effectiveness.

However, over time, clinicians have gradually refined the technique of the procedure, so it is unclear how effective these new methods are in real-world settings. Additionally, few real-world studies have examined the procedure outside of early clinical trials.

Recent research helps fill this gap in our understanding. The authors presented their findings at the Heart Rhythm 2024 conference in Boston, Massachusetts.

Doctor Paul S. Zey, MD, of Brigham and Women's Hospital in Boston, Massachusetts, is one of the authors of the new study.

Zey explained that he and his colleagues “believed that if a group of experienced electrophysiologists in a real-world setting could come together and collect data to evaluate detailed procedural practices, including innovations that group members had introduced into their standard practice, it could be a way to create real evidence that could improve the results of procedures."

Zey and his team analyzed information from a registry called Real Experience with Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation (REAL-AF).

This multidisciplinary registry was founded in 2019 by Zey and colleagues. Comprising 50 medical centers, it is designed to evaluate long-term outcomes in patients treated for AFib.

It is important to note that all of these medical centers regularly perform RF ablation procedures and use new advanced techniques such as:

• target the pulmonary vein, an area where AFib often begins;
• minimizing fluoroscopy during the procedure - this reduces radiation exposure;
• uses shorter, more powerful radiofrequency pulses to speed up the procedure.

Analysis of results

Scientists analyzed data from 2,470 patients with AFib treated with RF ablation to create the REAL-AF registry.

All participants had paroxysmal atrial fibrillation, a form of AFib in which symptoms come and go over time. The researchers particularly focused on the techniques used and the timing of the procedure.

They assessed the results of patients immediately after the procedure and after a year.

"We looked at experienced operators and centers to try to make sure we were learning the best techniques that were already in use," Zey explained. "Our motivation is to study the best approaches to RF ablation and adapt and improve these approaches so that our results become even better."

Data from the REAL-AF registry showed that RF ablation procedures were more effective, efficient, and safe than data from randomized clinical trials. This is quite an amazing discovery.

"Typically, real-world registries show lower efficacy than many randomized trials," said Shefal Doshi, MD, a board-certified cardiologist and electrophysiologist.

Doshi explained that this is because "in clinical practice, physicians may not follow study protocols or techniques and may experience suboptimal results. In this example, this registry showed even better results with improvements in RF ablation procedures that do not is common and shows the power of a learning healthcare network."

Doshi, who was not involved in the study, is director of cardiac electrophysiology and pacing at Providence Saint John's Health Center in Santa Monica, California.

One year after the procedures, 81.6% of participants had no atrial arrhythmia.

It is important to note that the vast majority - 93.2% - had no symptoms of arrhythmia within 12 months after the procedure.

The scientists also found that the average procedure time was significantly shorter. This means patients have to spend less time under anesthesia, which is safer and frees up clinicians' time to perform more procedures.

The authors conclude that improvements in RF ablation for the treatment of paroxysmal AFib "have resulted in excellent short- and long-term clinical results."

A look into the future of AFib treatment

The authors plan to expand their research to study other forms of AFib, including persistent AFib, which is more difficult to treat.

"The goal is to spread best practices to every operator and center," Zey explained.

Zey said he and his team will continue to collect and analyze data using the REAL-AF registry.

"As this registry gets larger and more data is collected, we are reaching a point where we can now use this network of physicians as a learning healthcare network where data generation, clinical implementation, and improved outcomes can be continually implemented." p>

New techniques are also being developed, including so-called pulsed field ablation, which uses electric fields instead of heat to destroy heart tissue.

RF ablation is still the most common technique today, so continuous improvement of the procedure is important. Additionally, Zey and his team "plan to evaluate pulsed field ablation as participants gradually adopt these platforms."