Catheter Ablation of Atrial Fibrillation Should Be Offered as Primary Therapy: What’s Your Hurry?

Wedam, Erich F.; Haigney, Mark

doi:10.1016/j.ccep.2015.05.020

Cardiac Electrophysiology Clinics

2015

DOI: 10.1016/j.ccep.2015.05.020

|View full text |Cite

Catheter Ablation of Atrial Fibrillation Should Be Offered as Primary Therapy: What’s Your Hurry?

Erich F. Wedam

Mark Haigney

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2018

2019

Publication Types

Select...

Article2

Relationship

Self Cite0

Independent2

Authors

Journals

Cited by 2 publications

(2 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prophylactic PVI in patients with only typical AFL must be well‐validated before it is introduced into clinical practice. The sequential ablation approach has clinically less expected risk, and there appears to be no compelling reason to adopt a combined ablation approach into standard practice …”

mentioning

confidence: 99%

Right atrial flutter as a marker of biatrial substrate for atrial fibrillation: Is more always better?

Özeke¹,

Çay²,

Özcan³

et al. 2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

We read with great interest the article by Koerber and colleagues 1 titled "Prophylactic Pulmonary Vein Isolation (PVI) during Cavotricuspid Isthmus (CTI) Ablation for Atrial Flutter (AFl): A Meta-Analysis" about the importance of the prophylactic PVI during CTI ablation on long-term atrial fibrillation (AF) recurrence without significantly increasing major complications. Despite the increased procedure and fluoroscopy times, there was no significant increase in major complications. 1 We want to address some points that merit more attention and would like to hear author's opinions about the importance of prophylactic PVI in the current era of only symptomatic relive of AF ablation. [2][3][4] Although CTI is considered curative therapy for typical AFl, many patients develop an AF after ablation during a long-term follow-up period and maintained over time. 5 It seems probable that the variability in the reported incidence of postablation AF is related in large part to varying intensities of monitoring. Although no patients had a prior diagnosis of AF in these studies, it is certainly possible that many were already having silent episodes prior to ablation. 6As authors stated, both the REDUCE AF 7 (Pulmonary Vein Isolation to Reduce Future Risk of Atrial Fibrillation in Patients Undergoing Typical Flutter Ablation: Results from a Randomized Pilot Study) and the PREVENT-AF (Prophylactic pulmonary vein isolation during isthmus ablation for atrial flutter) 8 trials reveled that prophylactic PVI reduced new-onset AF and burden in patients with lone AFl during clinical follow-up, with consequent reduction in hospitalizations and need to perform repeat ablation for AF. As expected, the procedure times were longer with combined approach. The main finding in current meta-analysis also was the significant reduction in recurrent atrial arrhythmias with prophylactic PVI at the time of CTI for typical AFl among subjects without a prior history of AF. 1 AFl and AF could be manifestations of a more general electrophysiologic disease, 9 perhaps; these results are not unexpected if we consider the pathophysiology of the both atrial diseases, which may share common triggers and arrhythmogenic substrate in a background of biatrial fibrosis. Therefore, the eradication of the flutter circuit will not prevent the eventual manifestation of AF. 10 However, no ablation is free from risk and these must be weighed against the potential benefit, and the only AFl patients at very high risk of AF might theoretically benefit from prophylactic PVI. 6 The HATCH score (which is based on hypertension, age ≥75 years, transient ischemic attack Any relationship with industry: No. or stroke, chronic obstructive pulmonary disease, and heart failure) has been found a useful predictor of new-onset AF after CTI. 11 AF induced by pacing protocols in patients undergoing CTI also predicts for future AF. 12 Therefore, asymptomatic patients with very high risk of AF should be screened for recurrent arrhythmias indefinitely after CTI. However, because the only in...

show abstract

mentioning

confidence: 99%

Right atrial flutter as a marker of biatrial substrate for atrial fibrillation: Is more always better?

Özeke¹,

Çay²,

Özcan³

et al. 2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…The results of ongoing CABANA and EAST trials are not expected until 2018 or 2019. In the meanwhile do we really need to be in a hurry for ablation procedure with the intention of preventing atrial structural remodeling without randomized evidence? 36 On the other side, one wonders if the results of the CABANA and EAST trials will really change the clinical practice, even if the results are negative?…”

mentioning

confidence: 99%

Post-truth era and cardiology: After ORBITA, before CABANA

Özeke¹,

Çay²,

Özcan³

et al. 2018

Indian Heart Journal

View full text Add to dashboard Cite

The evidence-based medicine is rooted in the scientific truth. Oxford Dictionaries has released its 2016 word of the year: "Post-truth," which they define as "relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief". In everything from climate change denial to the anti-vaccine movement, we're seeing the consequences of a failure to engage with scientific evidence. Fake news and post-truth pronouncements are increasingly common in social media and political era and are unfortunately also progressively being applied to the medical science. We also see some evidence of post-truth signals in daily cardiology procedures and guidelines including both interventional cardiology and cardiac electrophysiology. Guideline recommendations made before the randomized-controlled trials (RCT) are published might result in a scenario that the interventions or procedures have been performed on millions of people, costing billions of dollars, leading to unnecessary use of health care resources and often, ending up being even accepted as routine procedures in certain clinical situations. "Justice delayed is justice denied" is a legal cliché meaning that if timely justice is not provided to the sufferer, it loses it importance and violates human rights. In medicine, "The RCT delayed is justice denied", as highlighted by ORBITA (Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina) trial and as may happen with CABANA (Catheter Ablation versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial) in the post-truth era.

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

customersupport@researchsolutions.com

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Catheter Ablation of Atrial Fibrillation Should Be Offered as Primary Therapy: What’s Your Hurry?

Cited by 2 publications

References 37 publications

Right atrial flutter as a marker of biatrial substrate for atrial fibrillation: Is more always better?

Right atrial flutter as a marker of biatrial substrate for atrial fibrillation: Is more always better?

Post-truth era and cardiology: After ORBITA, before CABANA

Contact Info

Product

Resources

About