To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Advanced Treatment of Atrial Flutter Holds Up in Long-Term Follow-Up URL: http://www.pslgroup.com/dg/5FA2.htm Doctor's Guide November 14, 1995
ANAHEIM, Calif.-- Nov. 14, 1995 -- Long-term follow-up of heart patients treated with radiofrequency energy to cure a problematic heart rhythm disorder called atrial flutter shows that most maintain a normal heartbeat after treatment, University of California San Francisco researchers report. Atrial flutter is a type of atrial arrhythmia, an abnormal heart rhythm that affects the right atrium, one of the heart's blood-holding chambers. Atrial arrhythmias account for about 10 percent of hospital admissions in patients 70 and over, according to study director Michael D. Lesh, MD, assistant professor of medicine at UCSF. The researchers analyzed how patients fared after tiny bits of heart tissue that contributed to their heart rhythm abnormalities were destroyed during a procedure called catheter ablation. "Catheter ablation is more cost-effective than drug therapy or surgery, and patients report a remarkable improvement in their quality of life," Lesh said. "Our new study shows that in patients with atrial flutter, catheter ablation has a high success rate and cure is maintained over the long-term in the majority." The results of the study were reported at the American Heart Association's 68th Scientific Sessions in Anaheim today (November 13) by Leslie A. Saxon, MD, assistant professor of medicine at UCSF. In atrial flutter, abnormal electrical activity in the heart results in disruption of the heart's natural pacemaker, leading to ineffective pumping. The blood tends to pool in the atrium, and sometimes forms clots that travel to the head and cause strokes. The heart has to work harder to supply oxygenated blood to all the body's tissues, causing fatigue. To locate heart tissue responsible for the abnormal electrical signaling, the physicians place tiny electrodes into the heart. The electrodes are deployed from a thin flexible plastic tube, or catheter, which is threaded upward through a vein in the groin into the heart. The electrodes are the source of EKG tracings taken from different points in the heart, which are used to pinpoint to within two to three millimeters the source of electrical conduction that results in arrhythmia. The physicians then use a radiofrequency transmitter housed in the catheter to focus energy on the errant heart muscle tissue. The energy heats and destroys a small sphere of tissue about seven millimeters across, breaking the faulty circuit and restoring normal heart rhythm. The UCSF team followed 51 patients treated with catheter ablation for atrial flutter between 1991 and 1995. On average, patients had lived with atrial flutter for five and one-half years prior to catheter ablation. The majority of patients had a history of recurrent atrial flutter, with 75 percent coming to UCSF for catheter ablation after failing multiple-drug treatments. In addition, 63 percent had previously been treated with electrical shocks administered to the chest. Forty-five percent had shown symptoms of atrial fibrillation, a more serious and complex heart-rhythm disorder that frequently develops after atrial flutter. Normal heart rhythm initially was restored in 88 percent of patients, and in 100 percent of the 30 most recently treated patients. During follow-up, atrial flutter returned in 10 patients, and catheter ablation was repeated in seven of these, with normal rhythm returning in six. At the conclusion of follow-up, which averaged 14 months, 82 percent of the study group maintained normal heart rhythm. Catheter ablation was pioneered in the mid-1980s by Melvin M. Scheinman, MD, professor of medicine at UCSF, and other UCSF cardiologists. They were the first to use direct current shocks to treat rapid heart rhythms and later were among the first to develop the use of radio frequency waves to cure arrhythmias. Before the development of catheter ablation, open-heart surgery to sever the unwanted pathways was the standard treatment for patients with life-threatening heart rhythm problems that failed to respond to medication. Catheter ablations require a hospital stay of less than a day in most ases, compared to a week or more for open-heart surgery. Other contributors to the UCSF study include Scheinman, Jonathan M. Kalman, MD, PhD, clinical instructor; Jeffrey E. Olgin, MD, electrophysiology fellow; and Randall J. Lee, MD, PhD, assistant professor, all of the Department of Medicine. CONTACT: UCSF | Jeffrey Norris, 415/476-2557 --------------------------------------------------------------------------------------------- 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. 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