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  • Radiofrequency-based ablation for atrial fibrillation appears more effective than previously shown in clinical trials.
  • Using real-world data, a new study found that the procedure eliminated atrial arrhythmias in more than 80% of participants at a one-year followup.
  • Radiofrequency-based ablation works by applying bursts of energy to tissue in the heart via a catheter. The subsequent formation of scar tissue disrupts the abnormal electrical signaling that causes AFib.

A procedure to treat atrial fibrillation may be even more effective than previously demonstrated due to improved technology and modern interventions.

Radiofrequency-based ablation (RF ablation) is the most common form of ablation used to treat atrial fibrillation. The process works by using a catheter to deliver bursts of radiofrequency energy to areas of the heart and creating scar tissue to block abnormal electrical pathways.

The process has proven to be safe and effective in clinical trials, but new data from real-world medical centers indicates even better performance.

In a study published this week in the journal Heart Rhythm, researchers found that RF ablation resulted in over 80% of patients being free from any form of atrial arrhythmias at a one year follow-up period. Nearly 90% of patients also stopped taking anti-arrhythmic drugs as well.

“These results are certainly better than what we have seen in previous years, and they reflect the significant improvements that the atrial fibrillation ablation procedure has benefited from,” said Miguel A. Leal, MD, an Associate Professor of Medicine at Emory University School of Medicine, and Chair of the American Heart Association’s Electrophysiology & Arrhythmias Committee. Leal wasn’t affiliated with the research.

Rod Passman, MD, a Professor of Medicine and Director of the Center for Arrhythmia Research at Northwestern University who wasn’t affiliated with the research, told Healthline seeing real-world data for procedures like this is valuable in fast-moving health fields:

“These are helpful studies because often these technologies are assessed in clinical trials. To see the real world efficacy through a large number of operators is very useful.”

The study, led by researchers from Brigham and Women’s Hospital, utilized data from 42 high-volume institutions, and nearly seventy-nine experienced operators who performed the procedure.

In total, 2,470 patients who underwent RF ablation between 2018-2022 were included in the study. The average age of the patients was 65 years old; 44% of the cohort was female.

At a one year follow-up, 82% of patients were free from atrial arrhythmias, and nearly 90% had stopped taking anti-arrhythmic medications. Both endpoints showed improvement over the numbers previously seen in clinical trial data.

“It’s an important reinforcement of the idea that radiofrequency ablation for atrial fibrillation is effective, safe, and really has improved patient outcomes,” said Zachary T. Yoneda, MD, an invasive electrophysiologist who works in the Vanderbilt Atrial Fibrillation Precision Medicine Clinic, and Assistant Professor of Medicine at Vanderbilt University Medical Center. Yoneda wasn’t affiliated with the research.

The procedure had a complication rate of 1.9%, about one in 50 procedures, which the authors state is low and comparable to other data sets.

Despite the apparent success of the procedure, there is still work to do to improve efficacy and safety, Passman told Healthline.

“While the results are favorable, there’s still room for improvement. We still have success rates of only 80% or so. We still have complication rates of around 2%. So this means that we’re not done,” he said.

The RF ablation procedure has been studied in clinical trials, but the field has advanced in many ways since then. The culmination of those advancements, which are both technological and procedural, have yielded better performance from the procedure than initially observed, according to the study.

Advancements in the field include things like contact force sensing catheters, zero or reduced fluoroscopy (radiation associated with catheter procedures), and pulsed field ablation.

“The field continues to evolve, with the relatively recent adoption of different energy sources (with a potential for even greater efficacy and safety), as well as the experimental evaluation of other techniques that target neurological inputs to the heart in the effort to suppress atrial fibrillation,” said Leal.

At the end of 2023, the American Heart Association also updated its guidelines for the treatment of AFib, which includes greater detail about when patients should seek out catheter ablation procedures.

RF ablation is the most common form of ablation procedures for atrial fibrillation, the most common type of heart arrhythmia. It occurs when the atria, the two upper chambers of the heart, contract irregularly and rapidly, resulting in them going out of sync with the other chambers of the heart.

Abnormal electrical impulses, which signal the heart to beat, cause the irregular heartbeats in the atria.

Ablation works by acting on the heart to remove the “faulty wiring” that causes abnormal electrical signals to pass through the atria.

There are several different strategies used for AFib ablation including:

RF Ablation – Uses radiofrequency energy from a catheter to ablate (burn) areas of the heart to create scar tissue that interrupts abnormal electrical signaling.

Balloon Cryoablation – Balloon cryoablation uses extreme cold temperatures to ablate heart tissue and disrupt electrical pathways.

Pulsed Field Ablation – A non-thermal ablation technique that destroys cells directly through exposure to electrical fields.

Radiofrequency-based ablation may be more effective for atrial fibrillation than previously shown in clinical trials.

New real-world data indicates that more than 80% of patients who received the procedure were free from any form of atrial arrhythmia at a one-year followup. Nearly 90% of patients had stopped taking anti-arrhythmic medication.

Experts say that advancements both technologically and procedurally in the field of catheter ablation have made it even more safe and effective.