Surgical procedure best for common heart problem
Treating a common heart rhythm disorder by burning heart tissue with a catheter works much better than drug treatments, a new study has found.
The study looked at atrial fibrillation, a relatively common heart condition that happens when the heart loses its normal beat and literally quivers. The condition causes a racing heart, shortness of breath and weakness. And, because the heart fails to pump, blood can pool and clot, leading to strokes and heart failure.
Thousands of Canadians have the condition and the number is on the rise, due to an aging population and rising rates of obesity. It’s also a condition that hockey great Mario Lemieux had for years.
The conventional treatment for A-Fib -- as it’s sometimes called -- has been with medications to thin the blood and then “antiarrhythmic” medications to slow the heart rate and help restore normal rhythm, called beta blockers and calcium-channel blockers.
The medications are not always successful, and even when they are, the drugs' side effects, such as fatigue and weight gain, can hamper a patient’s quality of life.
Now, a new study published in Journal of the American Medical Association (JAMA), finds that the best treatment for some patients may be literally burning the heart tissue that is causing the trouble.
The procedure is called ablation therapy. Doctors thread a thin tube through the groin and into the heart. Then, a special machine is used to direct microwave energy to the tip of the tube which heats and destroys the heart muscle tissue that is the source of the chaotic electrical signals.
The study followed 167 patients with atrial fibrillation for whom medications failed to control their condition. The average age of the patients was 55, though most patients are often older.
Researchers randomly assigned 106 patients to receive ablation and 61 patients to try a different medication than the one they previously failed.
One year after having the ablation procedure, 66 per cent of patients were free of any A-Fib symptoms, compared with only 16 per cent of those treated with drugs.
Patients in the ablation group also reported significantly better average symptom frequency and better quality of life.
The results were so convincing the trial was halted early.
Dr. David Wilber of the Loyola University Medical Centre, who led the study, said the results are exciting.
“We now have something clearly demonstrated to be far more effective in controlling atrial Fibrillation and the symptoms, but in improving quality of life,” he said.
Wilber noted that the procedure does carry side effects, including irritation of the lining of the heart, bleeding, clots and stroke. However, it should also be noted that patients with A-Fib who can’t control their condition are also at risk of clots and strokes.
Dr. Eugene Crystal, the director of arrhythmia services at Sunnybrook Hospital in Toronto, who was not involved in the study, says while catheter ablation isn’t new, the study provides good proof that it works.
“We now have additional piece of evidence that it is worth doing this procedure at least in a subset of patients who are having significant symptoms and are reasonably young.”
But the problem, Crystal says is that demand for the procedure in Canada already outstrips supply. Many Canadian hospitals have three to 12-month waiting lists for the treatment.
“As the patients are becoming more and more aware of the procedure, it’s unlikely that the current level of resources will be able to handle it,” he says.