Rethinking Treatment for Atrial Fibrillation.

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting approximately one percent to two percent of the overall population. Treatment guidelines recommend a trial of drug therapy to maintain a normal atrial heart rhythm before catheter ablation is considered. However, these medications have only limited ability to maintain a normal heart rhythm and have substantial side effects.

Catheter ablation is considered superior to antiarrhythmic drugs in maintaining normal (sinus) rhythm and improving quality of life in patients in whom drugs already have failed, but it was unknown whether earlier ablation could prevent the progression of the disease.

"By treating patients with catheter ablation right from the start, we see fewer people advancing to more persistent, life-threatening forms of atrial fibrillation," says Jason Andrade, an electrophysiologist affiliated with the Montreal Heart Institute and assistant professor of medicine at Universite de Montreal.

Adds Laurent Made, chief of the electrophyslology service at MHI and co-chair of the Canadian Cardiovascular Society Atrial Fibrillation guidelines: 'The data provides clear evidence that an early invasive therapy may be a more effective method to improve the lives of our patients with atrial fibrillation. In addition, this study further supports the recommendation of pursuing catheter ablation as an initial treatment strategy in appropriate patients."

The findings, published in the New England Journal of Medicine, stem from a multi-site clinical trial known as Early Aggressive Intervention for Atrial Fibrillation (EARLY-AF). For the trial, the pan-Canadian research team enrolled 303 patients with AF at 18 sites across Canada. Half of the patients were randomly selected to receive antiarrhythmic drugs, while the other...