To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: ACC: Pulmonary Vein Isolation Promoted As "Cure" For Atrial Fibrillation URL: http://www.pslgroup.com/dg/214F12.htm Doctor's Guide March 20, 2002
By Peggy Peck ATLANTA, GA -- March 20, 2002 -- Pulmonary vein isolation for persistent, drug refractory atrial fibrillation (AF) was curative in more than 70 percent of patients, according to two recent studies. Both of these studies were presented today at the American College of Cardiology 51st Annual Scientific Sessions. Dr. Francis Marchlinski of the University of Pennsylvania Health System, Philadelphia, United States, reported that two months after undergoing pulmonary vein isolation for paroxysmal AF, "83 percent of patients were free of AF, with zero pulmonary vein stenosis and no stroke or TIA (transient ischemic attacks)." One patient did experience tamponade. In the second study, a series of 26 AF patients with impaired left ventricular function underwent focal mapping and ablation of AF at the Cleveland Clinic Foundation, Cleveland, Ohio, and "the cure rate was 73 percent with a mean follow-up of 10 months," said Dr. Nassir F. Marrouche, lead author. In an interview, Dr. Marrouche said that "the cure rate was 87 percent with follow-up ranging from two months to 2.5 years" in a larger clinic series (260 patients) that included the 26 patients in his study Dr. Marchlinski's study compared the outcomes of 32 patients who underwent focal ablation, and 75 patients who underwent pulmonary vein isolation for elimination of pulmonary vein triggers. There were no statistically significant differences in age, gender, persistent AF, LA (left atrium) size, or history of AF between the two treatment groups. The number of failed drugs was 4.2 in the focal group and 3.7 in the isolation arm. At the end of the procedure, 16 percent of the patients in the focal group "still had persistent AF," compared to just 1 percent in the isolation group. Likewise, the two-month AF-free success rate in the focal group was 58 percent compared to 83 percent in the isolation group. Both treatments had a low serious complication rate, the doctor said. Based on this experience, his institution is no longer doing focal procedures. Among patients in Dr. Marrouche's study, the mean left ventricular ejection fraction was 38 percent ±7 and the mean AF duration was 4.5 years. Nineteen patients had ischemic cardiomyopathy, three had idiopathic cardiomyopathy, three valvular heart disease and one had hypertensive cardiomyopathy. All patients had failed a mean of four antiarrhythmic drugs. Ninety-eight pulmonary veins were mapped and successfully isolated, he said. At follow-up, seven patients experienced recurrence of AF. Five are in sinus rhythm with antiarrhythmic drugs and two underwent a successful second ablation. No severe or moderate pulmonary vein stenosis was seen during follow-up and no major complications observed. Dr. Marrouche said, "what atrial fibrillation patients want is a cure. They want to be off warfarin. This procedure gives them that option." But, Dr. D. George Wyse of the University of Calgary, Albert, Canada that he was skeptical. "Atrial fibrillation is a disease of aging, the incidence increases markedly after age 65. I think ablation may have a role in treatment of younger patients, those in their 50s, but I'm not sure it will be widely applicable in older patients," he said in an interview. Dr. Marrouche disagreed, pointing out that the Clinic's series of 260 patients includes "patients from age two to age 80." --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.