Features August 2015 Issue

Research: Catheter Ablation Best for Heart Failure Patients with Afib

Ablation is often better than medication for treating the irregular heartbeat in individuals with heart failure.

Catheters destroy tissue causing Afib at the pulmonary vein and the coronary sinus.

Using catheter ablation to treat atrial fibrillation (Afib) in patients who also have heart failure is more effective than using the antiarrhythmic drug amiodarone (Pacerone®, Cordarone®), according to a study presented earlier this year at the American College of Cardiology’s annual meeting. The study found that ablation reduced the recurrence of Afib episodes better than amiodarone, and reduced the rates of hospitalizations and mortality more effectively than the widely used Afib drug.

Amiodarone is one of only a few medications prescribed to help manage Afib symptoms. It’s usually prescribed only after other drugs have been shown to be ineffective.

Cleveland Clinic electrophysiologist Walid Saliba, MD, says it’s particularly important to get Afib under control in heart failure patients because they are quite vulnerable to Afib complications, such as stroke.

“Keeping this group of patients out of atrial fibrillation is definitely an unmet need today,” Dr. Saliba says. “They have higher hospitalization rates and higher recurrence rates of atrial fibrillation, because it tends to co-exist with heart failure.

Afib and ablation

Afib is an increasingly common condition of the heart’s electrical system. When a heart is in Afib, the electrical signals in the heart stop their usual pattern that synchronizes the beating of the upper and lower chambers. Instead, the upper chambers (atria) beat in a chaotic manner. As a result, the heart doesn’t pump efficiently. Blood can pool in the atria because it’s not being circulated properly through the heart. Pooled blood can form a clot, which can eventually make its way to the brain and cause a stroke. People with Afib are five times more likely to have a stroke than people without the abnormal heart rhythm (arrhythmia).

Catheter ablation involves the use of catheters, which are placed in a blood vessel of the groin and then guided to the heart. A machine sends an electrical charge through one or more of the catheters to small sections of heart tissue believed to be causing the arrhythmia.

Ablation doesn’t necessarily cure Afib. But in many patients, ablation keeps Afib episodes from reoccuring for a long time. Some patients may never have another Afib episode after ablation; however, subsequent episodes are likely even after the procedure. The hope is that they become less frequent and less severe.

Ablation is usually ordered when antiarrhythmic drugs can’t control symptoms. “This study found that overall mortality was eight percent in the ablation group, but 18 percent in the amiodarone group,” Dr. Saliba says. “This is a positive finding that helps reaffirm the results from other studies that show ablation offers the greatest chance of success for heart failure patients.”

Heart failure complications

When a patient has heart failure, the heart can no longer effectively pump blood to all the organs, muscles and tissue of the body. About half of the people with heart failure also have Afib. Researchers in this study noted that heart failure can sometimes affect the way a heart responds to ablation or antiarrhythmic drugs. But even though this was a small study (about 200 patients with Afib and heart failure), the results are encouraging that cardiac function may improve with the expanded use of catheter ablation.

Dr. Saliba says the more heart failure patients can maintain a healthy heart rhythm, the greater the odds of improving their quality of life. And if ablation is the key, they can also avoid some of the side effects of amiodarone, which can include dizziness, coughing, trembling, weakness and shortness of breath.

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