For those of you that don’t know me, I’ve been toying with the idea of going into EP. I found it to be really intellectually engaging, and a great field to really delve into the “why” of medicine. I came across this paper that answered an interesting clinical question: in patients with atrial fibrillation and symptomatic heart failure, does catheter ablation better than medical therapy in improving mortality or rehospitalization?
This study enrolled 363 patients from 2008-2016 in multiple centers in Europe and randomized patients to catheter ablation or medical therapy. The median follow up time was 37.8 months and the primary outcomes were: death or hospitalization for heart failure. The study included patients >18 years old with symptomatic paroxysmal or persistent atrial fibrillation, failure of antiarrhythmic therapy, left ventricular dysfunction w/ EF <35%, and NYHA Class II-IV. They excluded patients who had had previous ablations (there were other exclusionary criteria).
The authors found that catheter ablation was associated with a 16.1% absolute reduction in rehospitalization for heart failure or death compared to medical therapy alone. Catheter ablation was also found to have greater left ventricular ejection fraction and longer times in sinus rhythm.
There are a few limitations to this study. The generalizability of this study is limited. They included patients who had failed/refused arrhythmic therapy. This is a narrow segment of the population. Also within the medical therapy arm, rate control was allowed and rhythm control was encouraged. This makes it difficult to parse out if pure rate control is superior or equal to ablation.
Nevertheless, this may result in more ablation procedures for budding EP docs!