Radiofrequency ablation for atrial fibrillationBMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7289.777 (Published 31 March 2001) Cite this as: BMJ 2001;322:777
- Neil R Grubb, lecturer in cardiology (N.Grubb@ed.ac.uk)a,
- Steve Furniss, consultant electrophysiologistb
- a Cardiovascular Research, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW
- b Freeman Hospital, Newcastle-upon-Tyne
- Correspondence to: N Grubb
Atrial fibrillation is a common arrhythmia, especially among elderly people. Restoration of sinus rhythm by cardioversion or drug treatment improves symptoms, cardiac output, and exercise tolerance. Unfortunately, the recurrence rate in successfully treated patients is high. Research into the underlying electrophysiological mechanisms that cause atrial fibrillation has fuelled the development of new therapeutic approaches. This article describes the advances in understanding how the arrhythmia is generated and discusses the therapeutic potential of radiofrequency ablation.
We obtained information from several sources. We used Medline and BIDS to identify key papers, and we searched abstracts from the meetings of the American College of Cardiology, American Heart Association, and North American Society of Pacing and Electrophysiology between 1995 and 2000 for additional information on evolving technologies.
The prevalence of atrial fibrillation in the adult population is 0.5%, rising to 10% among people aged over 75 years.1 It is associated with a 5–6 fold increase in the incidence of stroke.2 A 70 year old person with atrial fibrillation thus has an annual risk of stroke or transient cerebral ischaemic attack of 5%.
Atrial fibrillation may be paroxysmal, persistent, or permanent. Paroxysmal atrial fibrillation is characterised by repeated, self terminating episodes of arrhythmia. This can progress to either persistent atrial fibrillation, in which an intervention such as direct current cardioversion may restore sinus rhythm, or permanent atrial fibrillation, which is resistant to cardioversion. Many patients with atrial fibrillation are asymptomatic, especially if their heart rate is not rapid. If symptoms do occur their severity is determined by the underlying state of the heart and the patient's heart rate at rest and during exercise.
Restoration of sinus rhythm with direct current or pharmacological cardioversion improves symptoms, cardiac output, and exercise tolerance and is initially successful in up to 90% of patients, but the rate …