In early May I attended the Heart Rhythm Society Conference in San Francisco, the world’s largest cardiac electrophysiology medical conference. It was fantastic seeing healthcare professionals trade stories of their craft and all the sleek company booths.
As a medtech market research analyst I need to know what emerging technology physicians will use. It’s with this in mind that I am always sensitive to news about devices meant to increase the success of ablation therapy for persistent atrial fibrillation (AF). The type of ablation that electrophysiologists do is done percutaneously with catheters snaked into the heart. These catheters then burn sites on the inner wall of the heart to stop the propagation of errant electrical signals that cause arrhythmia.
Paroxysmal AF is the less severe form of AF with pretty decent outcomes for ablation. As this year’s conference has shown, outcomes for persistent AF remain frustratingly poor. The STAR AF and OASIS trial showed worse outcomes when new kinds of ablation patterns were used in persistent AF.
This all stems from two facts: that AF is a complex disease and that electrophysiologists are trying to replicate what is done surgically. Surgical ablation is done on the outside of the heart during heart surgeries, usually for repairing or replacing the mitral valve. This mitigates the AF that mitral valve disease patients often have.
So some electrophysiologists are thinking about ‘hybrid’ or ‘convergent’ ablation procedures where catheters are used to ablate the inside of the heart and less-invasive surgical tools are used to ablate the outside of the heart. By accepting that persistent AF treatment will require a more invasive procedure, electrophysiologists are increasing the success rate for treating persistent AF.
But at what cost? Ablation therapy for AF is an elective procedure: there is little evidence that it reduces stroke risk and mortality. Ablation therapy is meant to alleviate the symptoms of AF. Are physicians willing to put persistent AF patients through surgery, with its recuperation time, just to alleviate symptoms? The hybrid procedure also needs to be performed in a room equipped with expensive electrophysiology equipment and have OR capabilities, an uncommon feature in most hospitals.
So now that all the attendees of HRS have returned home and to their daily routine, I will keep my eye on clinical trial results for the hybrid procedure. I will also ask if the most promising new technique to treat persistent AF is worth the cost for patients and the health care system.