This Harvard Medical School Continuing Education video examines these key questions: Who is an appropriate candidate for atrial fibrillation and which methods are most successful? Why do the definitions of ablation success vary across patient populations?
Dr. William Hucker, MD, PhD, a cardiologist at Massachusetts General Hospital, reviews pharmacological and nonpharmacological methods of achieving rhythm control and identifies the best strategies for patients, with a focus on evidence-based studies. Pulmonary vein isolation is discussed as well as efficacy endpoints.
00:00 | Introduction
00:32 | Rhythm control methods
01:19 | Identifying candidates for rhythm control strategies
02:00 | Overview of AF and ablation
03:55 | Defining the efficacy of ablation
08:13 | Summary
This video was peer reviewed by Dr. Jonathan Salik, TMD, MHPEd, Instructor of Medicine, Massachusetts General Hospital; and Dr. Sugantha Sundar, MD, Assistant Professor of Anesthesia, Beth Israel Deaconess Medical Center, to validate the quality and accuracy of the content. It was edited by affiliate physicians of Harvard Medical School, Anna Handorf, MD, Research Fellow in Pediatrics, Massachusetts General Hospital , and Bradley Petek, MD, Cardiovascular Performance Program, PGY-6, Massachusetts General Hospital.
References:
Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659-666. doi:10.1056/NEJM199809033391003
Kuck KH, Brugada J, Fürnkranz A, et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med. 2016;374(23):2235-2245. doi:10.1056/NEJMoa1602014
Boveda S. Cryoablation for Atrial Fibrillation: A Useful Technique Beyond Paroxysmal Forms of Arrhythmia?. Rev Esp Cardiol (Engl Ed). 2017;70(4):236-238. doi:10.1016/j.rec.2016.10.016
Andrade JG, Champagne J, Dubuc M, et al. Cryoballoon or Radiofrequency Ablation for Atrial Fibrillation Assessed by Continuous Monitoring: A Randomized Clinical Trial. Circulation. 2019;140(22):1779-1788. doi:10.1161/CIRCULATIONAHA.119.042622
Marrouche NF, Brachmann J, Andresen D, et al. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018;378(5):417-427. doi:10.1056/NEJMoa1707855
Packer DL, Mark DB, Robb RA, et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA. 2019;321(13):1261-1274. doi:10.1001/jama.2019.0693
Notice: At this time, the content in this video is not accredited.