A minimally invasive procedure that “rewires” the heart may be a better option than medication for patients with unremitting cases of the heart rhythm disorder atrial fibrillation, or AFib, according to results of a new clinical trial.
Atrial fibrillation raises the risk of stroke by five times and also increases risk of heart failure and early death.
Although minimally invasive procedures are increasingly being employed in patients with paroxysmal, or intermittent, AFib, guidelines still recommend patients with persistent AFib be treated with medications first.
In the study, 310 patients with previously untreated persistent AFib received either traditional medications or underwent pulsed-field catheter ablation with Boston Scientific's Farapulse system.
Under that process, physicians guide thin electrical leads through blood vessels into the heart to deliver short bursts of electrical energy to precisely target and eliminate the heart tissue responsible for triggering and sustaining the abnormal electrical signals.
“You can think of it as resetting the heart's electrical system,” study leader Dr. Jason Andrade of the University of British Columbia said in a statement.
One year later, 56% of patients who underwent ablation were free of abnormal heart rhythms, compared with 30% of those who had started on antiarrhythmic drug therapy, researchers reported at the Heart Rhythm 2026 meeting and in The New England Journal of Medicine.
The overall risk of serious adverse events was similar in the two groups, they found.
“Traditionally, we’ve taken a stepwise approach, starting with medications and moving to procedures later,” Andrade said. “What this trial shows is that, even in patients with more advanced AFib, earlier intervention with ablation can provide substantial benefits and better control of the disease.”
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