Is Atrial Fibrillation ablation partly placebo?

Back Is Atrial Fibrillation ablation partly placebo?

Dr Anna  Bjorkenheim, Orebro University,  Sweden.  JACC : Clinical Electrophysiology  28/6/17

Although both symptoms and burden of AF reduce after catheter ablation of AF, the symptoms after. The procedure often did not tally with the success reported by the clinicians. Freedom from AF or low burden  of AF was usually associated with  reduction in symptoms, but symptom relief also occurred where the procedure failed.  Conversely, some patients with a successful procedure as determined  by loop recorder, still reported symptoms.

The study followed 57 patients undergoing catheter ablation, 54 of them had 24 months of data.  43% underwent a repeat procedure. They reported their symptoms  on a six-item AF6 questionnaire and physicians graded their perception of symptoms on the EHRA scale of class I, no symptoms to class IV, disabling symptoms.

Where the AF burden was <0.5% at 6m, 12m and 24m there was significant correlation with reduction in symptoms. However where the AF burden was >0.5%,  42% reported as improving by at least 1 EHRA class. 

This appears to fit with other evidence and anecdotal reports. It is hypothesized that the reduction in symptoms despite rhythm failure may be due to denervation during the procedure rather than purely placebo. 

This is important because the procedure is usually commissioned on the NHS for reduction in symptoms rather than because of any evidence in reduced mortality or stroke prevention.

With the financial pressures on the NHS, it is important we have evidence that the procedure remains cost effective as well as clinically effective compared to medication and other treatments for AF symptom control.