AHRQ: Long-term benefits of RF catheter ablation to treat a-fib are unclear

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Little is known about long-term benefits of radiofrequency (RF) catheter ablation for treating atrial fibrillation, or the best methods and circumstances for applying it, according to research released July 6, and funded by Department of Health and Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ).

The 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 one year), but found little evidence indicating whether the procedure reduces the chance that patients will experience atrial fibrillation over the long term.

The research, which compared RF 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.

RF catheter ablation often is used when medications do not work, the agency said. "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," AHRQ said. "In addition, there is little evidence indicating the procedure's effectiveness when used as a first-line therapy instead of medication."

"Radiofrequency holds promise for treating atrial fibrillation, but it is clear that more research is needed to demonstrate its potential long-term benefits," said AHRQ Director Carolyn M. Clancy, MD. "This report crystallizes the questions that researchers need to ask going forward."

The report's authors called for more research on the effect of RF catheter ablation on quality of life. In particular, they said that 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.

Earlier this year, the FDA approved the first two ablation catheters -- from Johnson & Johnson's Biosense Webster and St. Jude Medical -- indicated for use in treating atrial fibrillation in the U.S. The FDA also found that there is no conclusive evidence that people whose symptoms are reduced with ablation are less likely to have a stroke. Therefore, the FDA endorsed the existing clinical guidelines that recommend that patients at risk for stroke continue to take preventive blood-thinning medications after RF catheter ablation.