Is Ablation Rx the Best First Choice for A-Fib?

By Amy Norton HealthDay Reporter
TUESDAY, Nov. 17, 2020 (HealthDay News) — A procedure that freezes bits of heart tissue may be a better option than medication for people with atrial fibrillation (a-fib, or AF), two clinical trials have found.
A-fib is a common heart arrhythmia in which the organ’s upper chambers (the atria) beat erratically. Though it is not immediately life-threatening, over time it can lead to complications like heart failure, or blood clots that cause a stroke.
Right now, the standard first-line treatment is medication, said Dr. Jason Andrade, lead researcher on one of the new studies.
Those drugs help control the heart’s rate and rhythm. If they fail to do that, patients may move on to another option called ablation. It’s a minimally invasive procedure in which doctors use heat or cold to destroy bits of heart tissue that are generating the faulty electrical signal causing the arrhythmia.
The two new trials challenged the notion that ablation should only be a second option.
“The approach with medications is largely treating a symptom,” said Andrade, who directs the Atrial Fibrillation Clinic at Vancouver General Hospital in British Columbia, Canada. “If we start with an ablation, we may be able to fix atrial fibrillation early in its course, which potentially means reducing the risk of stroke and other heart problems down the road.”
His team found that ablation was, in fact, a better first-line treatment.
A-fib patients who underwent ablation were half as likely to have an arrhythmia episode in the following year compared to patients on medication. And they were 61% less likely to have an episode that caused symptoms.
The findings were simultaneously published Nov. 16 in the New England Journal of Medicine and reported at an online meeting of the American Heart Association.
“Ablation is more successful than medication for AF, though neither is 100%,” said Dr. Nieca Goldberg, an AHA spokeswoman and cardiologist at NYU Langone Health in New York City.
She noted that longer-term results are still needed, since trial patients were followed for only a year. “But I don’t think medication will become any more effective over time,” Goldberg added.

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