Agency News and Notes

Targeted energy treatment helps correct irregular heartbeat in the short term, but long-term effects are unknown

A procedure that sends targeted energy into the heart through a catheter can be used to treat a common type of irregular heartbeat. However, little is known about the treatment's long-term benefits and the best methods and circumstances for applying it, according to a new report funded by the Agency for Healthcare Research and Quality (AHRQ). The report examines the use of a procedure called radiofrequency catheter ablation to treat a type of irregular heartbeat known as atrial fibrillation. This condition affects more than 2.2 million Americans, putting them at risk for heart failure, blood clots, or stroke.

The new 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 1 year). It found little evidence indicating whether the procedure reduces the chance that patients will experience atrial fibrillation over the long term. The report, which compared radiofrequency catheter ablation with medication-based therapy, also found that the effect of the procedure on stroke, a major risk for patients with atrial fibrillation, is unknown. Radiofrequency catheter ablation—a procedure in which a long, thin, flexible tube is threaded through a blood vessel into the heart—often is used when medications do not work to prevent recurrence of atrial fibrillation (about half of patients). In this procedure, energy pulses are delivered through the catheter to the heart, destroying small areas of heart tissue where abnormal electrical signals may cause an arrhythmia to start.

Earlier this year, the U.S. Food and Drug Administration (FDA) approved the first two ablation catheters indicated for use in treating atrial fibrillation in the United States. However, physicians often use other catheters that have not been approved by the FDA for atrial fibrillation. The FDA explicitly endorsed existing clinical guidelines that recommend that patients at risk for stroke continue to take preventive blood-thinning medications after radiofrequency catheter ablation. The FDA recently approved a new medication, dronedarone, for treatment of atrial fibrillation. For more information go to: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm170276.htm.

AHRQ's new report, Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation, is the newest analysis from the Agency's Effective Health Care program. Information on the program, including the new report, can be found at http://www.effectivehealthcare.ahrq.gov.

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