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Is Radio-frequency Catheter Ablation for Atrial Fibrillation Ready for Prime Time with Patients and Doctors — Share Your Opinion

AHRQ Reviews 120 Radio-frequency Catheter Ablation Studies

August 21, 2009 5:47 AM CT

A study of radio-frequency catheter ablation by the Agency for Healthcare Research and Quality (AHRQ), part of the US Department of Health and Human Services, was one of the first Comparative Effectiveness Research (CER) studies released under the government-mandated CER initiative.

According to the AHRQ study press release:

"The report examines the use of a procedure called radiofrequency catheter ablation to treat a type of irregular heartbeat known as atrial fibrillation. The new comparative effectiveness report found that the procedure has been shown to provide benefits in maintaining normal heart rhythm over short periods of time (up to 1 year) but found little evidence indicating whether the procedure reduces the chance that patients will experience atrial fibrillation over the long term. The report, which compared radiofrequency catheter ablation to medication-based therapy, also found that the effect of the procedure on stroke, a major risk for patients with atrial fibrillation, is unknown."

"While there is no strong evidence to suggest that one particular technique is best for any given patient, there is general consensus concerning a basic approach to ablation procedures for atrial fibrillation. In addition, there is little evidence indicating the procedure's effectiveness when used as a first-line therapy instead of medication. The report calls for more research on the effect of radiofrequency catheter ablation on quality of life. In particular, more research is needed for groups of patients for whom the research is especially lacking, such as women, the elderly, and patients who have other conditions such as heart failure or high blood pressure."

Several studies are currently underway, or will commence soon, that should fill in some of the outlined gaps.

In this report, you'll find an amazing and vast array of data and results from 120 studies worldwide of radio frequency catheter ablation, the most common form of catheter ablation today. Here you'll find the major studies of RF catheter ablation all in one place. They did not study cryothermy or microwave energy sources, or surgery for atrial fibrillation.

If you're considering a catheter ablation, this report is packed with valuable information on every procedural combination that you can think of. But at nearly 800 pages for the full report and appendices, it's not for the faint of heart.

They analyzed such things as:

  • Results of RF catheter ablations vs. medication
  • Patient characteristics, including type of afib, age, gender, and other medical conditions
  • Procedures used, including pulmonary vein isolation (PVI) and wide-area circumferential ablation (WACA), as well as each by itself and with other ablation lines added, plus a few other variations
  • Outcomes from each study, including success and adverse events

Read: Executive Summary, Full Research Review, and Final Appendices

Special Request:

Can you help me? I'll be participating on a panel at the AHRQ 2009 Conference on September 14, 2009 where this specific study will be discussed. I would love to bring your thoughts and comments to that discussion.

Below are three questions that the panel will discuss, and I'd love your thoughts based on the results of this catheter ablation study:

  1. What is the perception of different stakeholders (including patients and physicians) about the state of the evidence of emerging technologies and the balance of potential benefits and harms?
  2. What messages are reaching patients and other stakeholders from the media, direct-to-consumer advertising, or other sources?
  3. How do we communicate what is known and what is not yet known about emerging technologies?

Please send me your thoughts via any of the following means by 9/12/09:

Thanks so much for your help in making sure that our voice is heard and incorporated in atrial fibrillation studies.

UPDATED 9-9-09: I'd love your input on the following additional questions:

  1. Do you consider it necessary to wait for evidence-based guidelines that are based on clinical trials to recommend catheter ablation before you have one?
  2. If not, what do you need to help you make that decision?
  3. How do you know when you have enough information that you're willing to make the decision?
  4. What should the Agency for Healthcare Research and Quality (AHRQ) do differently next time in an evaluation such as this? What are they overlooking?

 

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Last Modified August 21, 2009

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