Dr. Pierre Jais on Whether Long-Term Catheter Ablation Results are “Sobering” or “Encouraging” — Video
In this video interview at Boston Atrial Fibrillation Symposium, Dr. Pierre Jais, of the University of Bordeaux (Bordeaux, France), clarifies his group’s recently-published long-term catheter ablation results. These results were called “sobering” in the media (“Sobering” long-term outcomes following ablation of atrial fibrillation), but Dr. Jais sees them as encouraging.
The results, reported in the January 11, 2011 issue of the Journal of the American College of Cardiology, came from Drs. Michel Haïssaguerre and Pierre Jais and their team at Haut-Lévêque Hospital in Pessac, Bordeaux France. In this study, one hundred patients who received catheter ablations from January 2001 to April 2002 were followed to determine outcomes. Approximately one-third of these patients had persistent or longstanding persistent afib. After a single catheter ablation, the five-year freedom from arrhythmias was just 29%. But when measured from their last ablation, with a median of two procedures, 87% were free of arrhythmias at one year, 81% at two years, and 63% at five years. Those with valvular heart disease or cardiomyopathy were more likely to have a recurrence, and those with longstanding persistent afib were almost twice as likely as those with paroxysmal or persistent afib to have a recurrence.
In the video, Dr. Jais says, “We’ve been dealing with difficult patients—this was back in 2001—and the procedure was not quite the same as the one we are using now. We were using segmental, which was really ostial venous isolation, as compared to a much more proximal antral isolation that we use now, which has been proven to be more effective. I think that if we were to reproduce the study today, the results would be even better.”
These weren’t just ordinary afib cases either. Because of their reputation for stopping afib, this team drew some of the most stubborn and resistant longstanding persistent cases from around the world, some of whom had suffered from afib for two or three decades, or more. So with one-third being persistent or longstanding persistent, a 63% success rate at 5 years with no drugs is very encouraging, especially considering how far ablation techniques and tools have progressed in nearly a decade since.
But even those considered failures were often much better off. The definition of success was “no arrhythmia, or episodes of less than 30 seconds”. “Some of the patients who are considered failed are doing very well with just one episode of 30 seconds or one minute over five years,” says Jais.
So, these results are actually encouraging—not sobering—in light of where we are today and how far the field of catheter ablation has come in just under a decade.
View the video (3 minutes long):
About Pierre Jais, MD:
Professor of Cardiology
Centre Hospitalier Universitaire de Bordeaux
At the Haut-Lévêque Hospital in Pessac, Bordeaux France
Dr. Jais received his MD from the University of Bordeaux in 1993. He specializes in arrhythmias and has contributed in developing catheter ablation for atrial fibrillation. An important contribution was made with the demonstration of the role of pulmonary veins in AF. Dr. Jais has authored more than 70 journal publications and book chapters focusing on electrophysiology and radio-frequency catheter ablation, with particular attention to atrial arrhythmias. (Source: Boston Atrial Fibrillation Symposium)
For more information, see:
- “Sobering” long-term outcomes following ablation of atrial fibrillation
- Catheter Ablation for Atrial Fibrillation: Are Results Maintained at 5 Years of Follow-Up?, Journal of the American College of Cardiology, January 11, 2011
Mellanie True Hills: This is Mellanie True Hills, with StopAfib.org. I’m at Boston Atrial Fibrillation Symposium today, talking with Dr. Pierre Jais from Bordeaux, France.
Dr. Jais, Recently, there’s been a lot of discussion in the media about a paper that you guys published in Bordeaux about the results at five years out from catheter ablation, and it’s been called sobering. I actually think the results are quite encouraging, so would you be willing to share with us some about this study, and also introduce where you’re located?
Dr. Pierre Jais: Thank you, Mellanie. I am Pierre Jais. I’m a professor of Cardiology at the University of Bordeaux, and I work in the Haut-Lévêque Hospital, where we receive patients from pretty much everywhere in the world. I share your comments about the results of this study. I think we were missing long-term results for catheter ablation of atrial fibrillation, and this five year study was really important. But I feel that the results are encouraging, in fact.
The reason for that is that we’ve been dealing with difficult patients—this was back in 2001, a long time ago—and the procedure was not quite the same as the one we are using now. We were using segmental, which was really ostial venous isolation, as compared to a much more proximal antral isolation that we use now, which has been proved to be more effective. I think that if we were to reproduce the study today, the results would be even better.
Having said that, and given the fact that 35% of the patients were persistent or longstanding, I still think that 65% success rate at five years is pretty good with no drugs, and given the fact that the definition for the success was no fibrillation at all, or episodes less than 30 seconds. It means that some of the patients who are considered failed have been doing very well with just one episode of 30 seconds, or one minute, over five years, so all this has to be taken into account when looking at the results.
Mellanie True Hills: Absolutely. Thank you, Dr. Jais, for sharing with us your perspective on this. Again, I do believe that these results are extremely encouraging. From Boston Atrial Fibrillation Symposium, this is Mellanie True Hills, for StopAfib.org.