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Surgery More Effective Than Drugs in Treating Irregular Heartbeat

Catheter ablation may be the best option for people with atrial fibrillation after medication fails.

Study Findings

  • A surgical treatment that burns parts of the heart may be the best option for people with a common abnormal heart rhythm when medication fails, according to a new study.

When muscles in the atria, the upper chambers of the heart, quiver erratically, the result is a rapid and irregular heartbeat called atrial fibrillation, a condition that affects more than 2 million Americans a year and accounts for 15 percent of all strokes. The condition becomes more common—and more dangerous—as people age. Between 3 and 5 percent of people over age 65 have it.

Medication is the first choice of treatment but is ineffective half the time. Now David Wilber, M.D., and his colleagues at the Loyola University Stritch School of Medicine in Chicago report on a second compelling option that relieves symptoms and improves quality of life.

The researchers looked at 167 patients who had unsuccessfully used drugs to control irregular heartbeat. The participants, whose average age was 55, were divided into two groups: 61 of them were given another medication. The rest were treated with catheter ablation, a procedure in which a thin flexible tube is guided through the veins and into the heart’s atrium. Then electrical impulses destroy (ablate) the source of the irregular heartbeat by searing the heart muscle and forming a scar. The scar acts as a barrier to keep the abnormal quivering from jumping to the rest of the heart and causing the irregular beating.

“It’s like creating a firebreak,” says Wilber, director of Loyola’s Cardiovascular Institute and lead author.

The result: One year later, 66 percent of the patients whose heart tissue was burned experienced no irregular heartbeat, compared with 16 percent of those who used medication. In the head-to-head comparison, the procedure worked so much better than drugs that researchers halted the trial early.

But J. Michael Mangrum, M.D., director of the Atrial Fibrillation Center at the University of Virginia Health System in Charlottesville, warns that the findings can’t be applied to everyone with atrial fibrillation because researchers studied only patients with a type of the irregular heartbeat that occurs intermittently.

“While this study provides additional evidence of the benefit of this treatment, subjects were limited to . . . only about 20 to 30 percent of the larger group,” Mangrum says.

The study comparing treatment (drug therapy versus catheter ablation) was published online in the January 27 Journal of the American Medical Association. It was funded by Biosense Webster, which provided the catheters.

Cathie Gandel is a freelance writer based in New York.

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