In this free-access CardioEd resource from the recent Cardiology Update 2016 meeting organised by St George’s University of London, UK, Dr Riccardo Cappato, Head of Research Institute Electrophysiology and Clinical Arrhythmology at Humanitas Hospital in Milan, Italy, talks about catheter ablation in atrial fibrillation.
The Cardiology Update 2016 meeting focused on heart failure management and stroke prevention in patients with atrial fibrillation.
What are the two most important developments in the management of atrial fibrillation from the viewpoint of an electrophysiologist in the past two years?
I would not dichotomise this into two separate fields because the two most relevant fields belong to the same specific field – the first was the introduction of catheter ablation of atrial fibrillation, and the second was its cautious development over the last few years.
It was first introduced in 2000, and it addressed for the first time the option of a curative treatment of atrial fibrillation. A century-long lasting recognised arrhythmia for humankind that was always untreatable before. So this was an enormous paradigm shift in our capacity for approaching atrial fibrillation.
However, the first outcomes were not as optimal as we might expect at a time when we first recognised that we were able to do it. When we first recognised this, we thought ‘its fixed’ and our expectation was enormously high – say 85 to 90% success rate for every person who would approach atrial fibrillation with catheter ablation. But we soon recognised that success rates were much lower, and recurrence would occur at a later stage, in 70 to 80% of the population.
So it was only 20 to 30% of the initial population undergoing catheter ablation in atrial fibrillation that was really fixed by that procedure – which was still an enormously relevant outcome, but less so than expected based on the original findings.
When we recognised that more was required in order to improve and increase the number of patients who would be fixed with catheter ablation, we soon developed mapping and ablation strategies that would increase the original findings.
And we can now say that catheter ablation of paroxysmal atrial fibrillation can be fixed in 70 to 80 % of the patients presenting with this arrhythmia, and that persistent atrial fibrillation can be fixed in about 50% of the patients – and this by the first ablation procedure.
I think these are the two most relevant findings. And now many patients who previously were resigned to living with AF their entire life can enjoy a life of normal sinus rhythm after catheter ablation.