Interview with Dr. Riccardo Cappato at Boston Atrial Fibrillation Symposium 2010

Feburary 23, 2010 5:35 AM CT

In part 1 of our video interview with Dr. Riccardo Cappato at Boston Atrial Fibrillation Symposium 2010, he discusses the results of the Second Worldwide Survey on AF Ablation.

In part 2 of our interview, he talks about atrial fibrillation and athletes.

Dr. Cappato is a cardiologist and Chief of the Arrhythmia and Electrophysiology Department at the Center of Clinical Arrhythmia and Electrophysiology at the Policlinico San Donato, Milan, Italy.

About Dr. Riccardo Cappato

View part 1 of our video interview with Dr. Cappato, where he discusses the Second Worldwide Survey on AF Ablation:

More details about the Second Worldwide Survey of AF Ablation:

View part 2 of our video interview with Dr. Cappato, where he discusses atrial fibrillation and athletes:

More information about Dr. Cappato’s Boston Atrial Fibrillation Symposium 2010 talk about afib and athletes:

Video Transcript:

Part 1:

MTH: This is Mellanie True Hills. I’m at Boston Atrial Fibrillation Symposium 2010. With me today is Dr. Riccardo Cappato. He is a cardiologist and chief of the arrhythmia and electrophysiology department at the Center of Clinical Arrhythmia and Electrophysiology at [Policlinico] San Donato in Milan. He has talked here about the second worldwide study on catheter ablation, and he’s also talked about afib in athletes. We’re going to ask him about both of those topics.

So, first of all, Dr. Cappato, thank you for taking the time to talk with us today. I’d like to ask first about the second worldwide catheter ablation study/survey, and what are some of the new findings from that?

Dr. Riccardo Cappato: Well, first of all, this was a large study, the aim of which was to collect as much information as possible on the current standards about methodology, the efficacy, and the safety of a recently introduced technique to cure atrial fibrillation in humans, namely catheter ablation. You should be aware that this technique was introduced in clinical practice in 1995, and since those years has dramatically developed. However, our capacity to control the enthusiastic development of this technique has been quite limited. Therefore, in 2002, we contemplated the possibility to collect data systematically and raised the first survey. The main data of the first survey showed that proposal of these techniques is improving dramatically, doubling almost every year between 1995 and 2002, which were the monitored years of the first survey.

With the second survey, and I come now to your question, we were monitoring the years between 2003 and 2006. What became evident was that the methodology has improved, efficacy has improved, and safety has been guaranteed throughout the development of the study. More than 6,000 patients became available for data analysis, undergoing about 20,000 procedures. So the data that we were able to show, and the increasing efficacy and safety, are consistent with solidity. And I think that we can well claim that our results are substantiated by solid evidence.

MTH: So were there any new findings that have come out since the first time—you reported on some of that last year—and were there perhaps new findings that came out in subsequent analysis? Is there any of that you would like to share with us?

Dr. Cappato: Well, you know, the survey is essentially trying to track the standards of care. So, we certainly cannot claim about major findings, but we can try to describe what’s going on. What we saw is that there is care in the medical community to approach patients with this disease; there is awareness about the potential result of an intervention, a minimal intervention strategy; and there is also experience, which is growing, showing that the success rates that were in the range of 52% during the first survey raised up to 70% during the second. There was a dramatic 18% increase in efficacy that may well affect a wide population with AF, and for all those who may in the future benefit from this procedure.

This improvement stands for care, dedication, engagement, and skillfulness. It is a mixture of all these talents that the wide community of physicians has been able to put together worldwide. I think it’s a major enterprise, because improvement has been achieved at the cost of no increased hazard, which is also important I think. No matter how minimally invasive this procedure is, there is always a potential risk of producing undesired troubles to the patient. Now, being able to improve without touching the level of risk is an additional tribute that we have to give to the community of physicians worldwide.

MTH: So, as it’s becoming more widespread, it’s becoming a much safer procedure, and the efficacy has gone up as well.

Part 2:

MTH: Yesterday, you talked a lot about athletes—high performance athletes—and afib and exercise. That’s an area that we haven’t really delved into at Boston Afib much in the past. They were fascinating findings—would you share some of that with us as well?

Dr. Cappato: Sure. As many of our audience can imagine, suffering of atrial fibrillation is already a major pain in everybody’s lives. This perception doubles or triples whenever you’re an athlete. In some way, you not only have to perform physically at a higher level than in daily routine activity, but when you have to plan your daily life in the context of some time which is dedicated to sport—if you have passion or if you are in the competition field—you simply cannot imagine that something happens to your body changing the delicate balance that will allow you every day to perform and to plan according to your best wish.

Now, atrial fibrillation is there to give you trouble. If atrial fibrillation ensues, it will affect not only your cardiac performance, not only your sport performance, but your ability to plan doing sports. This will influence your sense of well-being much more than the occurrence of a normal arrhythmia can do. So there is an additional value in providing these people with a curative treatment that will allow them to go back to normal sport activity.

This opportunity was not available until very recently, so you can intuitively understand the dramatic impact that introducing catheter ablation of atrial fibrillation may have in this specific field. So not only do we resume a normal perception of well-being, but we give these people the chance to go back and perform their beloved sport activity.

MTH: Can you share with us just a little bit more about the results that you shared yesterday?

Dr. Cappato: Right. My center is also a referring center for sport activity. This is basically related to the incredible work that Dr. Furlanello made in our center for many years. He has been an extraordinary source of knowledge and development of interaction with the sport field, giving us also the chance to improve our skillfulness and our awareness about this problem. So we combined the high volume of referrals of sport athletes with our daily interest in fixing arrhythmia problems.

When catheter ablation of atrial fibrillation became available, we were for the first time in the position to offer our patients the possibility to contemplate a comeback to real sport or top-ranking performances. We started this project in 2000, and ever since 28 athletes presented with atrial fibrillation and with an indication to undergo catheter ablation. After 1 to 3 procedures, and a median of 1.7, meaning that for every 3 patients there is 1 requiring a second procedure, we were in the position to fix the problem in all 28 patients. They could all come back to competitive sport activity. It is important to note that 4 of them were professional sport athletes, and with 2 of them belonging to the top world ranking. So there was an extra value in these cases to give these people the chance to go back and perform at their desired level.

MTH: Well, these were fascinating results that you presented yesterday. Dr. Cappato, thank you so much for sharing with us the things that you have presented here at Boston Atrial Fibrillation Symposium. For, this is Mellanie True Hills.