Authors' objectives:

This study aims to assess the usefulness of radiofrequency ablation in the management of atrial fibrillation.

Authors' results and conclusions: Results are reported in conformance with the stated objective: cardiac frequency control or restoration of the sinusal rhythm. As regards cardiac frequency control, 2 randomized clinical trials and some case series are included. In clinical trials, patients were randomized to receive therapy with drugs vs. ablation of the AV node with posterior placement of a pacemaker. In both clinical trials patients showed better scores in scales specifically designed to measure related symptoms (dyspnea, palpitations) though no differences in the ergometry or echocardiography were found.With the objective of restoring the sinusal rhythm, some case series and two clinical trials, being one randomized and the other not, were included. In the last few years there has been a rate of success of approximately 70% in the case series analyzed. In the non randomized clinical trial (1171 patients) radiofrequency ablation (isolation of pulmonary veins) was compared against drug therapy. After two years of follow up, less deaths were observed in the ablation group 6% vs. 14% (Relative risk [RR] 0,46 IC95% 0,31-0,68) and a lower rate of FA relapse 20% vs. 58% patients were observed (RR 0.30 IC95% 0.24-0.37). In the other trial analyzed, 137 patients were randomized to undergo radiofrequency ablation and antiarrhythmic drugs vs. antiarrhythmic drugs only. In the ablation group, 44% of patients showed at least one relapse after one year follow up while in the control group, 91% of patients showed relapses. Complications in the procedure are uncommon though some of them may be serious.

Authors' recommendations: At present, radiofrequency ablation shows promising results in those patients with focal atrial fibrillation presenting drug intolerance or who prefer not to use long-term medication. Though good quality trials are still necessary to clear up the benefits and certain aspects related to which is the best technique to use, it is a practice usually covered in health organizations for focal atrial fibrillation with intolerance to drug therapy. For those patients presenting non focal or chronic atrial fibrillation this procedure is still at experimental stage being its use not recommended.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)