Performing Pulmonary Vein Antrum Isolation, or PVAI, early on may be the best solution for some patients with symptomatic atrial fibrillation (AF), according to MetroHealth Heart & Vascular Center experts. As the duration of AF increases, atrial enlargement and scarring makes the procedure less likely to be effective.

This point of view is supported by recently released results of the  Radiofrequency Ablation vs. Antiarrhythmiac Drugs as First-Line Therapy of Atrial Fibrillation study (RAAFT 2). RAAFT2 suggests that PVAI is safe as a first-line treatment for paroxysmal or persistent AF and that it is also more likely to suppress AF recurrences than standard antiarrhythmic drug therapy.

The RAAFT2 study showed that a single ablation procedure reduced the risk of AF recurrence by 44 percent compared with drug therapy.

“If you wait until the arrhythmia becomes persistent (requiring a shock to put the heart back in rhythm or continuous drug therapy to maintain it) the success rate of an ablation falls,’’ explained William Lewis, MD, MetroHealth’s Chief of Clinical Cardiology. “This study shows that choosing ablation early on, before extensive scarring occurs, is safe and effective.’’

Earlier ablation procedures also can impact quality of life for patients because some antiarrhythmiac drugs can have serious side effects, said Dr. Lewis.

“While guidelines in the United States suggest a trial of antiarrhythmic drug therapy before performing PVAI, these results suggest that symptomatic patients should be given a drug trial early and ineffective drugs should be abandoned quickly to increase success rates,” said Ohad Ziv, MD, the lead ablation specialist at MetroHealth. “Minimize the wait before you ablate” is the appropriate slogan.

While rate-controlling drugs can slow down atrial fibrillation, antiarrhythmic drugs are used to control the rhythm.

“Symptomatic patients often benefit from these drugs. However, some of their side effects can be serious” said Otto Costantini, MD, the director of MetroHealth’s arrhythmia service. “Our electrophysiologists are available to assist physicians in starting these drugs and suggesting when it is time to move on to ablation therapy.”

If you have a patient who has AF and might benefit from PVAI, MetroHealth Heart & Vascular Center experts can see physician referrals within a few days of calling.