Clinician-to-Clinician Update Clinician-to-Clinician Update

Radiofrequency Catheter Ablation Returns Patient to Active Lifestyle

June 2016

Contributed by Huagui Li, MD, PhD, FACC

Radiofrequency catheter ablation is an effective therapy for patients who have recurrent episodes of arrhythmia despite receiving antiarrhythmic medications. Here we describe an active, middle-aged male patient with episodes of recurrent atrial fibrillation (AF) that required cardioversion in the emergency department to resolve symptoms. Although he did not find treatment with an antiarrhythmic agent satisfactory, his AF was successfully managed with a radiofrequency catheter ablation procedure to isolate the pulmonary veins. He remains free from arrhythmia at 1-year postprocedure.

Case-Study-Article-June-2016-Heart-Care-AFib-Arrows
— Cross-section of heart and heart conduction system. Arrows indicate area of pulmonary vein ablation. Image copyright Medical Art Inc. courtesy iStock.

Patient

A 52-year-old male presented to the University of Minnesota Health Atrial Fibrillation Center with rapidly worsening AF. The patient previously had a very active lifestyle and enjoyed biking and fishing. Approximately 5 years earlier, he had experienced an episode of AF that required cardioversion in the emergency department of his local medical center. He subsequently continued to experience episodes approximately twice per year. He was referred to a local cardiologist, who prescribed an antiarrhythmic agent. The patient discontinued the medication, however, because of the side effects and because he did not wish to take a daily medication. Over the 2 months prior to presenting at our center, the patient experienced 3 AF episodes that required cardioversion, and his local cardiologist referred him to our care.

Management

Given that the patient discontinued treatment with an antiarrhythmic agent and was not likely to adhere to daily medication, physicians with the M Health Atrial Fibrillation Center suggested a radiofrequency catheter ablation procedure to isolate the pulmonary veins. The patient underwent the 2-hour procedure very successfully with no sequelae. Subsequent Holter monitoring revealed no evidence of AF. At 1-year follow-up, the patient was very satisfied. He had returned to his previous active lifestyle and had not experienced any episodes of AF since the ablation procedure.

Discussion

In a prospective, multicenter, randomized study of 167 patients who failed to respond to at least 1 antiarrhythmic drug and who had experienced at least 3 AF episodes within the prior 6 months, 66% of patients receiving catheter ablation (n=106) remained free of AF compared with 16% of patients treated with antiarrhythmic drug therapy (n=61). At 30 days post-therapy, major treatment-related adverse events occurred in 5 of 103 patients (4.9%) who had received catheter ablation and in 5 of 57 drug-therapy patients (8.8%). Furthermore, the mean quality of life scores collected at 3 months and 9 months improved to a significantly greater extent among the catheter-ablation patients than they did among those treated with antiarrhythmic medication.1 Thus, radiofrequency catheter ablation may be considered for select AF patients for whom first-line antiarrhythmic drug therapy fails.

References

  1. Wilber DJ, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010;303:333-340.
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