Catheter ablation underused in atrial fibrillation despite proven efficacy

MedTech & Diagnostics News: A new study highlights that nearly half of all patients hospitalised for atrial fibrillation (AF) in Australia and New Zealand do not survive beyond a decade. Surprisingly, despite its demonstrated efficacy, catheter ablation procedures remain vastly underused in treating this condition.

Dr Linh Ngo and her team from the University of Queensland’s Faculty of Medicine conducted a study, analysing data from over 250,000 patients admitted for atrial fibrillation (AF) and atrial flutter between 2008 and 2017 across public and most private hospitals in Australia and New Zealand.

“AF is the most common heart rhythm disorder and the leading cause of heart-related hospitalisations globally, causing symptoms like palpitations, dizziness, and chest pain,” Dr Ngo said. “The disorder is closely associated with stroke, but we know much less about the risk of recurrent hospitalisations and other consequences such as heart failure or death.

She further added, “Unfortunately, we found only 55.2% of patients hospitalised with atrial fibrillation survived beyond a decade. At 10 years, one in 10 patients had suffered a stroke, one in 6 were hospitalised for heart failure, and 41.2% had been readmitted due to recurrent atrial fibrillation or flutter.”

Co-author and cardiologist Associate Professor Isuru Ranasinghe from the Prince Charles Hospital emphasised that the study’s findings unveiled a concerning statistic: after 10 years, fewer than 7% of patients underwent catheter ablation procedures, despite its recognised efficacy as one of the foremost treatments for symptomatic atrial fibrillation.

“It may mean this procedure was underused in Australian and New Zealand hospitals,” Dr Ranasinghe said.

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A recent study, spearheaded by Professor Jon Kalman AO, Director of Heart Rhythm Services at the Royal Melbourne Hospital, scrutinised whether catheter ablation not only alleviates the physical aspects of AF but also enhances the mental wellbeing of patients, thus contributing to an improved quality of life. The results of this research delivered overwhelmingly positive outcomes.

“It has been shown that physical illness has a major impact on a patient’s mental health, and we’ve demonstrated this in patients with AF,” Professor Kalman said. “But what we’ve now shown is that catheter ablation helps reduce these impacts to mental health. It helps give patients their life back.”

Commenting on the newer generation of catheter ablation, pulsed-field ablation (PFA), Cardiologist A/Professor Haris Haqqani, St Vincent’s Private Hospital Northside and Prince Charles Hospital in Queensland, said “This technology is worth its weight in gold and it’s fair to say it’s quite revolutionary. It is clear that it is safer and more efficient for the patient.”

A/Professor Haqqani noted the importance of not having the patient under anaesthetic for a significant period, especially given that most of the patients who need this procedure are aged in their 60s, 70s and some in their 80s

“The actual ablation time with PFA is only around 15 minutes or less. With thermal ablation procedures you typically would only do one or two procedures in a session, but due to the greater efficiency and faster workflow of PFA, many more patients should be able to be treated in that time,” he commented.

A/Professor Haqqani did the first PFA procedure in Australia and the first outside Europe at Prince Charles Hospital in 2022.

“This will have an enormous positive impact on reducing surgical waiting times, particularly of course in the public system – which has waiting times of around two to three years in some hospitals, but also in the private hospital system,” he explained.

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Dr Ranasinghe said “Clinicians currently primarily focus on preventing the risk of stroke, but these findings emphasise the need to consider atrial fibrillation as a chronic disease with multiple serious downstream consequences.”

He added “There needs to be a greater focus on preventing recurrent hospitalisations and heart failure. The literature also suggests many patients at high risk of a stroke fail to receive blood thinning medications, so current preventative efforts are far from ideal.

“Better patient education in areas such as blood pressure control and weight loss, as well as appropriate preventative therapy in hospital and primary care could improve the outcomes for people with AF.”

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