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FAST: Surgical ablation superior to catheter ablation to achieve freedom from left atrial arrhythmia
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AHA Scientific Sessions 2011
ORLANDO, Fla. — Minimally-invasive surgical ablation was superior to catheter ablation at 1 year for the treatment of antiarrhythmatic drug-refractory atrial fibrillation with left atrial dilatation and hypertension or a failed prior catheter ablation, according to new data from the FAST trial.
At 1 year, 65.6% of patients randomly assigned to video-assisted epicaridal surgery ablation (n=61) experienced freedom from left atrial arrhythmia lasting for more than 30 seconds without antiarrhythmic drugs compared with 36.5% of patients assigned catheter ablation (n=63; P=.0022).
However, “surgical ablation is accompanied by a higher adverse event rate than catheter ablation,” Lucas Boersma, MD, PhD, cardiologist at St. Antonius Hospital, Nieuwegein, the Netherlands, said at a press conference. The procedural adverse event rate was 3.2% for catheter ablation vs. 23% for surgical ablation (P=.0431), and 13.1% and 11.5% during chronic follow-up.
According to Boersma, “these findings may be used by physicians and patients to guide optimal invasive therapy.”
Patients enrolled in the Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST) trial had antiarrhythmic drug-refractory AF with left atrial dilatation and hypertension (n=42) or failed prior catheter ablation (n=82). Researchers randomly assigned patients to undergo catheter ablation, which consisted of linear antral pulmonary vein isolation and optional addition lines, or video-assisted epicardial surgical ablation (n=61), which consisted of bipolar radiofrequency isolation of the bilateral pulmonary vein, ganglionated plexi ablation and left atrial appendage excision with optional addition lines. Electrocardiogram and 7-day Holter recording were performed at 6 and 12 month follow-up. - by Casey Murphy
For more information:
- Boersma L. LBCT.03. Presented at: the American Heart Association Scientific Sessions 2011; Nov. 12-16, 2011; Orlando, Fla.
- Boersma L. Circulation. 2011;doi:10.1161/CIRCULATIONAHA.111.074047.
Disclosure: Dr. Boersma is a consultant for Medtronic and Boston Scientific. The study was in part funded by a grant from AtriCure, but the company was not involved in the study in any other way.
AF is really important because large studies predict that up to
one-quarter of us are going to develop AF at some point in our lives. The
question is: What are you going to do about it? What are the best treatments
for different groups of people?
Although thousands of people in the US every
year, and many more across the world, have surgical ablation, mostly with
concomitant surgery, we don’t have a lot of data from randomized
controlled trials looking at results of surgical ablations. I congratulate
these investigators for doing one of the very few RCTs looking at surgical
ablation. As far as I know, [FAST] is the only RCT comparing two different
forms of ablation: catheter to surgical ablation.
– A. Marc Gillinov, MD
Staff Cardiac Surgeon
Cleveland Clinic Heart Center
Disclosure: Dr. Gillinov reports that he is a consultant to AtriCure and Edwards Lifesciences. He has received research support from Medtronic and St. Jude Medical. The Cleveland Clinic has the right to receive royalties from AtriCure for the sale of a device related to occlusion of the left atrial appendage.
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