Curing Afib with catheter ablation
Interview Professor Etienne Aliot
For any condition, a cure makes more sense than symptom management, yet atrial fibrillation is usually treated using drug therapy that has a limited effect. With more cases of Afib reported each year, and catheter ablation offering a cure, the coming years could see a bold change of emphasis.
Atrial fibrillation is an increasingly common condition as life spans increase and the incidence of other contributory factors such as diabetes and hypertension rises. With an estimated three million sufferers in Europe alone, and many millions more worldwide, effective treatments are much in demand.
Currently, therapy centres on finding the right combination of drugs to treat arrhythmia, which will depend on which of the many types of Afib - from paroxysmic to persistent - is exhibited and on the age and health history of the patient. However, the many sufferers are aware that the side effects of certain drugs often used to treat Afib can be dramatic, such as the skin pigmentation caused by Amiodarone.
'The guidelines for primary care indicate anti-arrhythmic drugs, but it is my feeling that these are limited in their efficacy and have unpleasant side effects,' says the well known French cardiologist Professor Etienne Aliot. 'Afib can be managed with drugs, but over 70 per cent of patients return with symptoms after five years. Study results show that sinus rhythm improvement can be achieved with drugs, but the positive effect is counterbalanced by the side effects.' Restoring sinus rhythm can also be achieved with the installation of a pacemaker, but the focus is still on controlling the symptoms rather than treating the condition.
Biosense Webster has extensive experience in developing advanced technology to diagnose and treat cardiac arrhythmia, and its new imaging and tracking tools are part of the reason why greater emphasis is now being placed on catheter ablation as a treatment for Afib.
Cure over control ?
Catheter ablation is increasingly replacing surgical procedures in the treatment of Afib, but Professor Aliot and others feel that its use should spread further, replacing drug therapies at an earlier stage of treatment. 'We are trying to cure the patient,' says Aliot. 'I used to tell people they had a chronic disease that could not be cured, but now, for some patients, we can take a new approach. Catheter ablation restores sinus rhythm without drugs.'
There are, of course, some risks that patients must be aware of before opting for catheter ablation. Pericardial tamponade is one example, but like most risks with this procedure it can be dealt with relatively easily. It must also be understood that the procedure cannot be applied in all cases, or with a 100 per cent guarantee of success. 'There are potential dangers, but they are familiar to all centres where this procedure is performed,' adds Aliot.
Furthermore, the risks are constantly being reduced as new technology is applied to the procedure to improve accuracy and efficiency. The use of cardiac imaging (i.e. CT and MRI) for instance, provides unprecedented views into the electrical cavity of the heart, while 3D navigation systems enable precise, real-time tracking of catheters.
Aliot firmly believes that we could be at a major turning point, 'Catheter ablation will change the way Afib is treated. In 2004 the total number of catheter ablations for Afib was 20,000. By 2007, we will probably have around 140,000 globally. This seems a lot, but not when there are millions of patients globally. We can't ablate everyone, so we must choose our patients.' So far, results in the treatment of paroxysmic Afib present in young patients are particularly encouraging.
Currently, guidelines stipulate two courses of drug therapy before non-medical therapy is considered. These rules may change in the future, and catheter ablation may move higher up the list of options for treatment, but economic factors may prove just as telling. With catheter ablation, patients require fewer, shorter hospital stays, freeing up cardiology resources. With broader supply, and better tools to hand, catheter ablation should become faster, more effective and much more common.