Atrial Fibrillation: Freezing Better Than Meds?


CLEVELAND, Ohio (Ivanhoe Newswire)— At least 2.7 million Americans are living with atrial fibrillation, or AF. It’s an irregular heartbeat or a “quivering” heart that left untreated, could lead to blood clots, stroke, or heart failure. Medication is the gold standard treatment, but a new study may lead to a change for doctors and patients.

Racing heart? Or a “fluttering” in your chest? They could be symptoms of AFib or AF, a condition where the heart is out of rhythm.

“The sooner we intervene and treat atrial fibrillation, the better, because if atrial fibrillation is allowed to continue, then those changes in the left atrium progress,” explained Oussama Wazni, MD, section head of electrophysiology and pacing at Cleveland Clinic.

(Read Full Interview)

Doctors at the Cleveland Clinic studied 200 patients with intermittent episodes of atrial fibrillation in the STOP AF FIRST trial. About half were treated with antiarrhythmic drugs, which is the standard treatment. The other participants had cryoballoon ablation; doctors inserted a balloon with liquid nitrogen to freeze the heart tissue causing the irregular heartbeat. At one year, 75 percent of the ablation patients were free from AF, compared to 45 percent of the patients on medication. Dr. Wazni says the results could eventually lead to a change in treatment.

“Maybe it’s time to circumvent needing to take an antiarrhythmic drug with all the side effects and ineffectiveness, and just proceed with an ablation,” said Dr. Wazni.

Researchers also studied the safety of cryoballoon catheter ablation as a first line treatment as part of the trial. Two safety events were observed in the catheter ablation arm, including a heart attack that doctors could not directly attribute to the ablation procedure. He says overall, the study showed the catheter procedure to be safe.

Contributors to this news report include: Cyndy McGrath, Executive & Field Producer; Roque Correa, Editor.

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REPORT:       MB #4840

BACKGROUND: Currently, there are at least 2.7 million Americans living with atrial fibrillation. Atrial fibrillation, also known as AFib or AF, is a quivering or irregular heartbeat called an arrhythmia. AF can lead to blood clots, stroke, heart failure and other cardiac complications. During a regular heartbeat, the heart contracts and relaxes allowing blood to move around the body in a normal, steady rhythm. In atrial fibrillation, there is an abnormal firing of electrical impulses causing the upper chambers of the heart, called the atria, to beat irregularly, resembling a quivering movement. This affects its ability to move blood into the ventricles. If a clot breaks off, breaks off and lodges in an artery leading to the brain, it will result in stroke. As many as 15 to 20 percent of stroke patients have AF. This clotting risk is why many AF patients are put on blood thinners.


DIAGNOSING: There are many signs of AFib, though a “quivering” or “fluttering” heartbeat is the most common. Sometimes AF patients have no symptoms, and the condition can only be detected by physical exam. Other symptoms include general fatigue, rapid heartrate, thumping in chest, dizziness, shortness of breath and anxiety, weakness, faintness or confusion, fatigue when exercising, sweating, and chest pain or pressure. There are a few different types of AFib and all have similar symptoms. However, the duration of the AFib can help doctors classify underlying problems. Paroxysmal Fibrillation is when the heartbeat returns to a normal rhythm on it’s own with no intervention with seven days. People with this type of AFib may only have  symptoms a few times a year or they can have them everyday. Persistent AFib is an irregular rhythm that lasts longer than seven days and will not return to normal sinus rhythm on its own and requires treatment. Long-standing AFib occurs when the heartbeat  is consistently irregular for longer than 12 months. Permanent AFib occurs when the condition lasts indefinitely and both doctors and patients have stopped intervention methods to restore normal rhythm. And nonvalvular AFib is AF that is not caused by a heart valve issue.


NEW TECHNOLOGY: Medication is the standard-of-care for all treatment intervention methods for all forms of AF. Paroxysmal AFib is typically first treated with anti-arrhythmic drugs, but now, researchers have found that due to improvements in the safety and efficacy of a catheter ablation procedure, they may now be more effective than medications as the first treatment for intermittent AF. The STOP AF FIRST trial studied 203 patients with paroxysmal AF not previously treated with medication. The patients were randomized to receive either cryoballoon catheter ablation or standard-of-care medications. In cryoballoon ablation, a catheter is inserted with an attached balloon filled with liquid nitrogen to freeze and immobilize the heart tissue that is causing the irregular heartbeat. After a year of the study, of the patients that received cryoballoon ablation, 75 percent of them were free from Afib with no further or additional treatment. In comparison to the group of patients that received standard-of-care medication, only 45 percent of patients had no signs of AFib.





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Doctor Q and A

Read the entire Doctor Q&A for Oussama Wazni, MD, Section Head of Electrophysiology and Pacing

Read the entire Q&A