Dr Mark Gallagher, Consultant Electrophysiologist at St George’s NHS Foundation Trust in London, UK, speaks with Cardio Debate & Radcliffe Cardiology about Treatment of Atrial Fibrillation during the “Advances in the Pathogenesis and Management of Cardiovascular Disease” 2015 meeting, organised by the Cardiovascular Sciences Research Centre of St George’s University and held at the Royal College of Surgeons of England in London, UK.
My name is Mark Gallagher, I’m a cardiologist and interventional electrophysiologist at St George’s University Hospital, London, UK.
How effective is ablation for treatment of AF?
Ablation is the most effective treatment we have for atrial fibrillation. It is particularly effective in paroxysmal atrial fibrillation, and particularly when paroxysmal atrial fibrillation is of relatively recent onset. Easier in structurally normal hearts, more effective in structurally normal hearts, and more effective in younger patients.
However, even in older patients, even in patients in their seventies, even in persistent atrial fibrillation that has been present for a year or two – it is quite effective, and is more effective than any of the alternative treatments such as antiarrythmic drugs or just repeated cardioversion.
Now when I speak of ablation I speak of catheter ablation or surgical ablation. There are strengths and weaknesses of either of those approaches, but ablation overall is far more effective than any of the alternative treatments to normalize the rhythm in atrial fibrillation.
When is it indicated?
Well it is indicated for the treatment of symptomatic atrial fibrillation. So in the asymptomatic patient it is still not really clear. There is some evidence to suggest that AF ablation may improve prognosis, but it’s not really clear-cut – not enough to offer it for that indication alone.
It is effective in removing atrial fibrillation and therefore removing the symptoms associated with atrial fibrillation, and so it is for the symptoms that we use it.
What are the current and future challenges?
Well the challenge is to deliver the therapy that is required to enough patients – to do so very safely, and effectively – to cure people on their first procedure.
At present we have to do repeat procedures in a substantial proportion of the patients who come for treatment of persistent atrial fibrillation. For paroxysmal atrial fibrillation we’re already pretty good at curing at the first procedure, but for persistent atrial fibrillation it often takes two or more.
So the big challenge is to cure those patients on first procedure, to cure a large proportion of them on the first procedure. And to do so with a minimal risk of complications, to keep the risk of all complications below one per cent, to keep the mortality of these procedures down to, say, less than one in 10,000. I think that would be a realistic objective.