Re: artrial fib

[Guest guest]

Francine,

Just found this in the Times. It seems to be a common problem, not necessarily

one directly related to CMT.

http://www.latimes.com/news/nationworld/nation/la-sci-atrial27-2010jan27,0,35275\

94.story

People with atrial fibrillation, a common type of irregular heartbeat, should be

referred for a surgical treatment called catheter ablation if an oral medication

is not effective, said the authors of a study released Tuesday.

In a head-to-head comparison of the two forms of treatment, catheter ablation

was so superior in resolving the disorder and helping patients to feel better

that the study was halted early. The results will be published today in the

Journal of the American Medical Assn.

Atrial fibrillation, which affects more than 2 million Americans, occurs when

the heart's two small upper chambers quiver instead of beating effectively. It

can cause blood to pool and clot, raising the risk of a stroke. The condition

can go undetected indefinitely, though many people have symptoms such as

palpitations, dizziness, chest pain, fatigue and shortness of breath. Once

considered a nuisance, the condition is now recognized as a potential precursor

to stroke that should be treated.

" It's really important that we have advances in treating atrial fibrillation

because the risk climbs dramatically as you age, " said Dr. Zipes, past

president of the American College of Cardiology and a cardiologist at Indiana

University School of Medicine. Zipes was not involved in the study. " I always

say -- only partially tongue-in-cheek -- that if you live long enough, you'll

have atrial fibrillation. "

The first choice for treating the condition is oral medications to reduce the

heart rate. They work by slowing the conduction of the electrical impulses in

the heart. Such medications, however, are ineffective in a large portion of

people with the disorder.

For those who continue to feel unwell, catheter ablation should be recommended,

said Dr. Wilber, director of the Cardiovascular Institute at Loyola

University Chicago Stritch School of Medicine and the lead author of the study.

" Atrial fibrillation has always been difficult to treat, " Wilber said.

" Certainly, the effectiveness of the drug therapies is about 50% at best. The

likelihood of a second drug working is about 20%. So the role of this study is

to point out that there isn't much point in going to a second drug. "

During catheter ablation, doctors make a small incision in the patient's neck or

groin and insert a thin, flexible tube to reach the heart. They then apply

radiofrequency energy to cauterize -- or burn off -- small pieces of abnormal

tissue triggering the irregular heartbeat.

The study was performed at 19 medical centers and included 167 atrial

fibrillation patients who had failed to benefit from at least one drug. The

patients, whose average age was 55, were randomly assigned to receive ablation

or try a different medication than what they had already tried. Most took

flecainide or propafenone.

One year later, 66% of the ablation patients were free of an irregular heartbeat

or symptoms, compared with 16% of those treated with drugs.

" This is an excellent study, " Zipes said. " It confirms what other studies have

also found. "

Longer studies are needed to assess whether the treatment provides a long-term

cure and if it reduces stroke and death, Wilber said.

Catheter ablation has been in use for several years but is still underutilized,

said Dr. Shephal K. Doshi, director of electrophysiology and pacing at Saint

's Health Center in Santa . Doshi was not involved in the study.

There are risks associated with the procedure. Rare complications include damage

to the esophagus and stroke. Damage to veins is a more common complication but

is treatable.

" It has to be used appropriately, but in the right hands it's a very powerful

tool for the management of atrial fibrillation, " Doshi said. " There is a 1% risk

of having a stroke during the procedure. So that's not trivial. For a young

patient, a patient who feels bad, it may be worth it. "