A catheter ablation protocol for atrial fibrillation (AFib) including only “the bare essentials” of the procedure delivered similar outcomes as a more involved strategy featuring pulmonary vein mapping, according to research presented at EHRA 2019 in Lisbon, Portugal.
According to a press release, 30 percent more patients could be treated with this simplified protocol for the same cost, offering hope of shrinking wait times for these procedures.
“Catheter ablation started in 1998. There has been little improvement in clinical outcomes in the last 10 years despite costlier technologies and a more complicated procedure requiring highly skilled staff,” principal investigator Prapa Kanagaratnam, PhD, of Imperial College London, said in the release. “In this trial, we stripped the procedure back to the bare essentials to see if it achieved the same outcomes.”
Kanagaratnam et al. randomized 321 symptomatic AFib patients to one of three treatments: cryoballoon ablation with same-day discharge; conventional cryoballoon ablation with pulmonary vein mapping and overnight hospitalization; or antiarrhythmic drugs. All patients spent 12 weeks getting their procedures and/or optimizing drug treatment before the one-year follow-up period began.
During follow-up, 21 percent of patients with the simpler ablation approach required rehospitalization, compared to 18 percent of those in the conventional ablation arm who underwent pulmonary vein mapping. This difference wasn’t statistically significant, but both ablation groups fared much better than patients treated with drug therapy alone—76 percent of them ended up back in the hospital to relieve symptoms.
“It is possible that more patients will now choose catheter ablation outright, rather than trying drugs first,” Kanagaratnam said. “The findings also question the value of drug therapy, and whether catheter ablation should be the first line treatment for atrial fibrillation patients with symptoms.”
And, given the statistically insignificant difference in hospitalizations among the ablation groups, Kanagaratnam said returning to a basic ablation approach might provide cost-effective and efficient care to more patients. This is of particular importance considering AFib is the most common heart rhythm disorder and causes between 20 and 30 percent of all strokes, the release stated.
“Some of the more technical parts of the procedure can be omitted, making it easier, cheaper and quicker, without sacrificing results,” Kanagaratnam said. “In the U.K., patients with atrial fibrillation have to wait months for catheter ablation. The simpler protocol could shorten waiting lists within the same budget.”