First line catheter ablation or drugs for paroxysmal atrial fibrillation?BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7274 (Published 29 October 2012) Cite this as: BMJ 2012;345:e7274
People with symptomatic paroxysmal atrial fibrillation can choose between antiarrhythmic drugs and radiofrequency catheter ablation. The two options looked equally effective (broadly) over two years in a head to head trial. An editorial (p 1648) says that either would be a reasonable first line treatment for relatively young fit patients, as long as they understand the different balance of risks and benefits.
A third (54/148) of the people assigned initially to drugs needed supplementary ablation at some point during the study, whereas only 9% (13/146) of those managed initially with ablation required supplementary drugs. Ablation was associated with a greater chance of being free from atrial fibrillation at two years (85% v 71%; P=0.004), a preliminary signal that ablation may be more durable. But ablation is certainly invasive and can be risky, says the editorial. Among 140 adults who had initial ablation in this trial, three had cardiac tamponade and one died from a procedure related stroke. Sixty nine patients required a second, third, or even fourth ablation for recurrent atrial or nodal arrhythmias.
So, although consensus is edging towards offering first line ablation to selected adults with paroxysmal atrial fibrillation, some will want to wait for bigger trials that explore mortality and morbidity, not just heart rhythm, in a broader selection of patients, says the editorial.
Cite this as: BMJ 2012;345:e7274