Destroying Heart Tissue to Make the Heart Stronger

Destroying Heart Tissue to Make the Heart Stronger

Catheter Ablation Emerging as Effective Treatment for Irregular Heartbeats

New York (Apr 27, 2010)

Atrial fibrillation, the most common type of serious arrhythmia (irregular heartbeat), is characterized by very fast, irregular electrical signals in the upper chambers of the heart called the atria. These electrical signals may travel through the atria at a rate of more than 300 per minute. The two most serious potential complications of chronic atrial fibrillation are stroke and heart failure.

Medication First Line of Treatment

Treatment with anti-arrhythmia drugs is usually the first form of therapy for patients with atrial fibrillation that causes symptoms (such as palpitations, anxiety, dizziness, fainting or the feeling of nearly fainting, sweating, shortness of breath, and/or chest pain). Today doctors are increasingly using an approach called "catheter ablation" to treat patients with atrial fibrillation that persists despite anti-arrhythmic medication. The cardiac electrophysiologists at NewYork-Presbyterian Hospital are very experienced and highly skilled in the use of catheter ablation to treat patients with atrial fibrillation, with some of the best outcomes in the nation.

Bruce Lerman, M.D.

"There are 2.4 million people in the United States with atrial fibrillation, tens of thousands of whom receive catheter ablation each year," said Bruce B. Lerman, M.D. "Yet many more may be eligible for this effective procedure which successfully restores heart rhythm and prohibits the need for lifetime medication in most patients."

How Catheter Ablation Works

During catheter ablation, the doctor threads a flexible catheter through a vein to the heart, and applies intense heat through it to destroy small areas of tissue where the arrhythmia originates. In some patients, the electrical connections causing the atrial fibrillation become re-established; these patients may need a second ablation procedure, usually several months after the first one. Most patients who have the procedure leave the hospital the next day.

Hasan Garan, M.D.

Catheter ablation is most effective for a form of atrial fibrillation called "paroxysmal" atrial fibrillation (which occurs occasionally), and is usually reserved for patients age 80 and younger. Patients over 80 are at more risk for complication, and as a result, the technique is only used in these patients in the most severe cases.

People with atrial fibrillation often receive blood thinners such as Coumadin to reduce the risk of blood clots and subsequent stroke. Catheter ablation may enable patients to forego Coumadin therapy and enjoy an improved quality of life as they achieve a normal heart rhythm.

The CABANA Clinical Trial

A multicenter international study called the Catheter Ablation versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation (or CABANA) Trial will be the largest study to date comparing catheter ablation with drug treatment for patients with atrial fibrillation. Funded by the National Heart, Lung, and Blood Institute, the study is enrolling 3,000 patients who will be randomly assigned to have a catheter ablation procedure or receive anti-arrhythmic drug therapy.

Results of the study will help physicians determine which treatment approach is best overall and, in certain circumstances, which therapy may be the preferred choice for an individual patient. NewYork-Presbyterian Hospital/Columbia University Medical Center is one of 140 leading centers from around the world to participate in the CABANA Trial.

Several prior studies have demonstrated that catheter ablation is superior to drug therapy for suppressing paroxysmal atrial fibrillation that causes symptoms, but they focused on relief of symptoms and quality of life, and included small numbers of patients. The CABANA Trial is the first to examine the impact of these therapies on objective endpoints such as total mortality, stroke, intracranial bleeding, and cardiac arrest, as well as cost of care and quality of life.

Said Hasan Garan, M.D., "If the CABANA study shows that ablation is superior to pharmacologic therapy for atrial fibrillation, it's possible that many eligible patients will be offered a choice of catheter ablation or drug therapy right up front."

Contributing faculty for this article:

Bruce B. Lerman, M.D. is Chief of the Division of Cardiology; Director of the Cardiac Electrophysiology Laboratory; and an Attending Physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. He is also the Hilda Altschul Master Professor of Medicine at Weill Cornell Medical College.

Hasan Garan, M.D. is Director of the Cardiac Electrophysiology Service and an Attending Physician at NewYork-Presbyterian Hospital/Columbia University Medical Center. He is also a Professor of Medicine at Columbia University College of Physicians and Surgeons.