Last week in Boston, the 30th annual meeting of the Heart Rhythm Society (HRS) highlighted a series of clinical studies that touted solutions for managing cardiac patients with abnormal heart rhythms. However, the sentiment of German writer J.W. Goethe encapsulates the complication of proposing one treatment choice as the epitome of therapies for this vast and complex patient population--caveats always arise.
After eight years of follow-up, the MADIT II trial found that the survival benefits increased by a year in heart attack survivors who received implanted cardioverter defibrillators (ICDs). However, this finding did not hold true for those patients who developed worsening heart failure.
Also, a few studies tackled the problem of lead extraction in the event that either a pacemaker or ICD lead malfunctioned. The four-year, retrospective LEXiCon study found a 97.7 percent clinical success rate and a 96.5 percent complete lead removal success rate with laser-assisted lead extraction in 13 U.S. and Canadian centers. However, even lead investigator Dr. Bruce L. Wilkoff acknowledged to Cardiovascular Business News that there is "a learning curve" associated with success rates of operators.
Two studies examined the application of antiarrhythmic drug therapy with varying outcomes. Despite high mortality rates associated with Multaq (dronedarone) in the earlier ANDROMEDA trial, the ATHENA trial found that the antiarrhythmic agent had no adverse effect on mortality in atrial fibrillation patients with stable heart failure, and patients had a lower incidence of primary outcome events when allocated to dronedarone therapy, compared to placebo.
Catheter ablation could be an alternative for patients with paroxysmal a-fib, who are unresponsive to prior antiarrhythmic drug therapy, as the results of the Thermocool AF trial showed a substantially reduced risk of recurrent atrial arrhythmias for those who underwent ablation. However promising the results, the study does not answer the question about whether catheter ablation is superior as a first-line therapy compared to the drug therapy.
With more than two million patients diagnosed with atrial fibrillation in the U.S., these questions and solutions about superior therapies will continue to unfold as various trials attempt to manage this complicated and growing patient population, along with all heart rhythm disorders.
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