Skip to main content
SpringerLink
Log in
Book cover

Cardiac Arrhythmias 2005 pp 251–256Cite as

Atrial Fibrillation Should Be Considered a First-Line Therapy — Or Not?

  • Chapter

  • 643 Accesses

Conclusions

The literature on ablation for AF has many of the features of clinical research in the era preceding evidence-based medicine and randomised trials. Many studies emanate from single centres, involve low patient numbers, and fail to provide adequate statistical analysis, including intention to treat analysis and evaluation of statistical power. As was the case with Maze operations, new procedures are continually proposed without completing satisfactory evaluations of previously proposed procedures. Very worrisome is that most studies have not involved neutral committees for the recording and supervision of severe complications.

The belief that AF ablation now represents a standard or, indeed, first-line treatment is excessively optimistic and may reflect occupational and economic factors encouraging mechanistic invasive procedures.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Pacifico A, Henry PD (2004) Ablation for atrial fibrillation: are cures really achieved? J Am Coll Cardiol 43:1940–1942

    Article  PubMed  Google Scholar 

  2. Kannel WB, Wolf PA, Benjamin EJ et al (1998) Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 82(suppl 8A):2N–9N

    Article  PubMed  CAS  Google Scholar 

  3. Wattigney WA, Mensah GA, Croft JB (2003) Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999. Implication for primary prevention. Circulation 108:711–716

    Article  PubMed  Google Scholar 

  4. Pappone C, Oreto G, Rosanio S et al (2001) Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation — Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 104:2539–2544

    PubMed  CAS  Google Scholar 

  5. Maggioni AP, Latini R, Carson PE et al (2005) Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the valsartan heart failure trial (Val-Heft). Am Heart J 149:548–557

    Article  PubMed  CAS  Google Scholar 

  6. Young-Xu Y, Jabbour S, Goldberg R et al (2003) Usefulness of statin drugs in protecting against atrial fibrillation in patients with coronary artery disease. Am J Cardiol 92:1379–1383

    Article  PubMed  CAS  Google Scholar 

  7. Ciaroni S, Cuenoud L, Bloch A (2000) Clinical study to investigate the predictive parameters for the onset of atrial fibrillation in patients with essential hypertension. Am Heart J 139:814–819

    Article  PubMed  CAS  Google Scholar 

  8. Nichol G, McAllister F, Laupacis A et al (2002) Meta-analysis of randomised controlled trials of the effectiveness of antiarrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation. Heart 87:535–543

    Article  PubMed  CAS  Google Scholar 

  9. Ferguson JJ, Califf RM, Antman EM et al (2004) Enoxaparin vs unfractioned heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. JAMA 292:45–54

    Article  PubMed  CAS  Google Scholar 

  10. Pappone C, Rosanio S, Augello G et al (2003) Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation — Outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol 42:185–197

    Article  PubMed  Google Scholar 

  11. Pacifico A, Henry PD (1996) Class I or Class III agents for atrial fibrillation: are we asking the right question? Pacing Clin Electrophysiol 26:1613–1619

    Article  Google Scholar 

  12. Waldo AL, Camm AJ, deRuyter H et al for the SWORD Investigators (2003). Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. Lancet 348:6–11

    Google Scholar 

  13. Savelieva I, Camm AJ (2000) Clinical relevance of silent atrial fibrillation: prevalence, prognosis, quality of life, and management. J Interv Card Electrophysiol 4:369–382

    Article  PubMed  CAS  Google Scholar 

  14. Israel CW, Grïsefeld G, Ehrlich JR et al (2004) Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device. J Am Coll Cardiol 43:47–52

    Article  PubMed  Google Scholar 

  15. Strickberger SA, Ip J, Saksena S et al (2005) Relationship between atrial tachyarrhythmias and symptoms. Heart Rhythm 2:125–131

    Article  PubMed  Google Scholar 

  16. Cook RC, Alscher KT, Hsiang YN (2003) A debate on the value and necessity of clinical trials in s urgery. Am J Surg 185:305–310

    Article  PubMed  Google Scholar 

  17. Wingerchuk DM, Noseworthy JH (2002) Randomised controlled trials to assess therapies of multiple sclerosis. Neurology 58:S40–S48

    PubMed  CAS  Google Scholar 

  18. Saririan M, Eisenberg M J (2003) Myocardial laser revascularization for the treatment of end-stage coronary artery disease. J Am Coll Cardiol 41:173–183

    Article  PubMed  Google Scholar 

  19. Grines C, Rubanyi GM, Kleiman NS et al (2003) Angiogenic therapy with adenovirus 5 fibroblast growth factor-4 (Ad5FGF-4): a new option for the treatment of coronary artery disease. Am J Cardiol 92:21N–31N

    Article  Google Scholar 

  20. Gaita F, Riccardi R, Calïs L et al (1998) Atrial mapping and radiofrequency catheter ablation in patients with idiopathic atrial fibrillation — Electrophysiological findings and ablation results. Circulation 97:2136–2145

    PubMed  CAS  Google Scholar 

  21. Bertaglia E, Stabile G (2005) Catheter Ablation for the Cure of Atrial Fibrillation (CACAF). Late-Braking Clinical Trials II, March 8, 2005. 54th Annual Scientific Session of the American College of Cardiology, Orlando, Florida

    Google Scholar 

  22. Saad EB, Rossillo A, Saad CP et al (2003) Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation — Functional characterization, evolution, and influence of the ablation strategy. Circulation 108:3102–3107

    Article  PubMed  Google Scholar 

  23. Ezekowitz MD, James KE, Nazarian SM et al (1995) Silent cerebral infarction in patients with nonrheumatic atrial fibrillation. The Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillatiion Investigators. Circulation 92:2178–2182

    PubMed  CAS  Google Scholar 

  24. Sabatini T, Frisoni GB, Barbisoni P et al (2000) Atrial fibrillation and cognitive disorders in older people. J Am Geriatr Soc 48:387–390

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Texas Arrhythmia Institute and Baylor College of Medicine, Houston, TX, USA

    A. Pacifico & P. D. Henry

Authors
  1. A. Pacifico
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. D. Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Divisione di Cardiologia, Ospedale Umberto I, Via Circonvallazione 50, I-30174, Venezia Mestre

    Antonio Raviele MD

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Springer-Verlag Italia

About this chapter

Cite this chapter

Pacifico, A., Henry, P.D. (2006). Atrial Fibrillation Should Be Considered a First-Line Therapy — Or Not?. In: Raviele, A. (eds) Cardiac Arrhythmias 2005. Springer, Milano. https://doi.org/10.1007/88-470-0371-7_33

Download citation

  • DOI: https://doi.org/10.1007/88-470-0371-7_33

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0370-5

  • Online ISBN: 978-88-470-0371-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation