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Sep 30, 2011

Early Intervention for Recurrent AFIB Most Effective

Early re-ablation effective in some patients with AFib.

Atrial fibrillation (AFib) is the most common type of abnormal heart rhythm affecting more than 2 million people in the United States. Atrial fibrillation is often characterized by an irregular and often rapid heartbeat caused by a malfunction in pumping by the chambers of the heart. This abnormal heartbeat can be chronic, lasting for prolonged periods of time, or instead may come and go, known as paroxysmal atrial fibrillation. In patients with paroxysmal atrial fibrillation, episodes are unpredictable and may only last for a few minutes or hours. Fortunately, a procedure known as catheter ablation has proven effective in curing patients with paroxysmal atrial fibrillation. However, this procedure is not 100% effective and some patients will continue to experience episodes of AFib after ablation.

In patients experiencing recurrences of AFib, the use of a second ablation procedure has been highly debated. Some experts believe that patients’ hearts need at least three months to heal before a second procedure should be performed, while others support the use of a second ablation procedure immediately upon recurrence of the condition. So which should be considered best practice for doctors treating patients with paroxysmal atrial fibrillation?

Researchers explored this question and recently published their findings in Circulation: Arrhythmia and Electrophysiology, a journal of the American Heart Association. In this study, 286 patients with paroxysmal atrial fibrillation underwent an ablation to correct this condition; 119 experienced no recurring atrial fibrillation. Among remaining patients with recurring atrial fibrillation, all were treated with antiarrythmic drugs while only some underwent early re-ablation (within 3 months after their initial procedure, following certain triggers of atrial fibrillation episodes). Researchers found that recurrence of atrial fibrillation was significantly reduced in patients undergoing early re-ablation in comparison with those receiving antiarrythmic drugs only.

Based on findings, early re-ablation may be effective in patients with atrial fibrillation recurrences when these episodes are triggered by certain causes. Therefore, waiting at least 3 months to perform re-ablation to treat paroxysmal atrial fibrillation may not be necessary in all patients, as some may benefit greatly from earlier re-ablation.

Questions for You to Consider

  • What is a catheter ablation?

  • Catheter ablation is a procedure that involves inserting a catheter (small tube) into an artery near the groin, threading it up to the heart and normalizing heart tissue with electrical signals. Ablation has proven 60-75% effective in treating patients with paroxysmal atrial fibrillation.
  • Who is at risk for atrial fibrillation?

  • Increased age, heart disease, high blood pressure, alcohol abuse and chronic cardiovascular conditions can increase risk for atrial fibrillation. Family history of this condition may also increase risk, as atrial fibrillation may be genetic.


Complications from AFib Procedure are More Common in Women than Men

Women with atrial fibrillation are more likely to experience complications after catheter ablation than men, but there is a silver lining to these findings.

Study Questions the Safety of Common Procedure for Treating Atrial Fibrillation

Mortality rates are found to be higher at medical centers that perform fewer catheter ablations than larger hospitals.

Resources to Help You Compare Treatment Options

Guidance from the Agency for Healthcare Research and Quality (AHRQ) in making health decisions

Bob's Story: Atrial Fibrillation

Learn how Bob Ek and his cardiologist, Scott J. Pollak, MD, FACC, work as a team to manage Bob’s atrial fibrillation.