Treatment of atrial fibrillation through ablation is more effective than antiarrhythmic drug treatment

A recent study, conducted in 8 hospitals in Spain and led from the Hospital Clínic - IDIBAPS, has randomly compared catheter ablation vs. antiarrhythmic drug in the treatment of persistent atrial fibrillation. The SARA Study (Study of Ablation vs Antiarrhythmic Drugs in Persistent Atrial Fibrillation) has been published as Fast Track in the journal European Heart Journal. After one year of monitoring, the study concludes that treatment with ablation is more effective than antiarrhythmic drugs in preventing relapse of the arrhythmia. In the group treated with ablation the 70% of patients did not present any long lasting relapse of the arrhythmia, whereas among patients treated with antiarrhythmic drugs only 43 % were free of relapse during the follow-up. Dr. Lluis Mont, from the Cardiology Department at Hospital Clínic de Barcelona and IDIBAPS investigator at the Arrhythmias, resynchronization and cardiac imaging Team, is the first author of the study, while Dr. Josep Brugada, from the same service and research team and also Medical Director of the Hospital Clínic, is the last one.

Atrial fibrillation is the most common arrhythmia, affecting approximately 4% of people over 60 years. The probability of presenting this arrhythmia during their life in people over 40 years is 25% (1 in 4), and it is especially prevalent in people over 80 years (10%). This arrhythmia causes symptoms such as palpitations, and increases the risk of stroke and heart failure. Moreover, despite being well tolerated in treated chronic forms of arrhythmia, the risk of death is doubled compared to people of the same age.

Treatment with antiarrhythmic drugs to prevent recurrences has limited effectiveness and involves some risks. In the past 15 years, catheter ablation techniques to treat this arrhythmia have achieved a healing therapy in a proportion of individuals with short crisis. However, until now had there was not any available study specifically aimed at patients with the "persistent" form of the disease. This form represents a more advanced stage of disease, and therefore until the present work has been published there was not enough information on what was the best treatment for these patients.

Reference: Mont L, Bisbal F, Hernández-Madrid A, Pérez-Castellano N, Viñolas X, Arenal A, Arribas F, Fernández-Lozano I, Bodegas A, Cobos A, Matía R, Pérez-Villacastín J, Guerra JM, Avila P, López-Gil M, Castro V, Arana JI, Brugada J; on behalf of SARA investigators. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J. 2013 Oct 17. [Epub ahead of print] Read the article