Thanks for the link, researcher.
The reviewers point out the limitations of CA in making effective blocking lines and how improvements in catheter design could help remedy this. Very interesting and heartening to sense that a lot of money and time is being poured into such efforts.
The authors point out that the Cox Maze III had a relatively high success rate, although I am told that it may have erred on the high side because follow-up determinations of the presence of AF were based on telephone verbal reports from patients. And currrent versions of the Cox Maze, although less invasive, are also less successful (see [
www.af-ideas.com])
It does, however, appear that the model the Cox Maze that attempts to section off areas in the LA with scar tissue that will effectively block or channel errant electrical impulses occurring now *or in the future* is held up as the goal of surgical procedures. For CA, my understanding is that the goal is reduced to making only those the lesions necessary to stop impulses that are currently causing problems. This is accomplished in a stepwise progression by those who are skillful enough to do so.
The review opens with introduction figures representing success rates for medication and CA. Reading those, a prospective patient would be awfully pessimistic about the chances of either medication or CA helping his AF, especially without a significant risk of complications. Here are the latest word-wide figures for the CA:
"The follow-up second worldwide multicenter survey on catheter ablation was presented at Boston Atrial Fibrillation Symposium 2009 and included data from 20032006. The success rate was 70% without antiarrhythmic drugs vs. 52% in the first survey, and 10% with antiarrhythmic drugs vs. 23.9% previously, with an overall total success rate of 80% in the second survey vs. 76% in the first. The success rate without drugs was much improved, though the number of procedures required for success is not known at this time. When broken down by type of afib, the success rate without antiarrhythmic drugs was 75% for paroxysmal afib, 65% for persistent afib, and 63% for permanent afib.3
The highest volume centers, those with over 300 procedures, had success rates of 75% without antiarrhythmic drugs,3 though that may have involved multiple procedures for some patients. "
I get this sinking feeling whenever I see worldwide statistics such as the above. There has been improvement, but how depressing!
The prospective patient, however, should not assume that these figures apply to him. He should realize that probabilities for *his* successful treatment will depend on characteristics specific to him, and also that he can probably do better by to one of the top-tier EPs mentioned on this BB (and asking him what his rates are).
-- Dick
