Long Term Outcomes in CASA AF LSPAF
Research type
Research Study
Full title
Long-term Outcomes in Long Standing Persistent Atrial Fibrillation Following Catheter Or Thoracoscopic Surgical Ablation : Extended Follow-Up Of CASA-AF Randomised Controlled Trial
IRAS ID
271930
Contact name
Tom Wong
Contact email
Sponsor organisation
Royal Brompton and Harefield NHS Foundation Trust
Duration of Study in the UK
1 years, 11 months, 31 days
Research summary
Research Summary
Atrial fibrillation (AF) is a condition detected as an irregular heartbeat. It is the most common rhythm disturbance worldwide which can lead to significant symptoms and serious health problems (stroke and heart failure).
The longer a person has AF, the more difficult it is to restore a normal heart rhythm. Those with continuous AF for longer than a year are described as having longstanding persistent AF (LSPAF). This is the most challenging type of AF to treat and medications are often not effective.
Apart from medications patients with LSPAF may be offered a medical procedure to help improve their symptoms. It involves putting a flexible thin tube (catheter) into a blood vessel in the groin and up into the heart to destroy the tissue causing irregular heart beat. This procedure has modest success in improving symptoms in the long term. Recently, keyhole surgery has been used for these patients and evidence shows that it is better than the catheter procedure. However, we do not know how well people are doing beyond one year.
Feedback from a patient focus group suggested that knowing the long-term results of these two procedures is important to help them make an informed choice when it comes to treatment.
In this study we propose to continue monitoring patients from a randomised clinical trial (CASA AF RCT) who have already had one of the procedures. They have a small heartbeat monitor implanted under the skin with a battery life of around 3 years. We will be able to look at their heart rhythm data for the duration of this period and detect the return of the fibrillation if it happens.Summary of results
One hundred and fifteen patients with symptomatic long lasting atrial fibrillation were treated with catheter ablation or surgical ablation. At the end of the procedure, they had a small electronic device implanted under the skin which recorded changes in their heart rhythm for three years. These data were reviewed by cardiac physiologists to identify patients whose arrhythmia returned. Patients completed questionnaires to help with evaluating symptoms related to atrial fibrillation, as well as their general health, at different time points. This information was then compared to the assessments provided at the beginning of the study before they had the intervention.
Heart rhythm data at the end of three years' follow up was analysed from 104 participants. The main finding is that 13% of patients continue to have normal heart rhythm, after just one intervention and without medications during follow up. This result is similar in patients who were treated by catheter ablation (7 out of 57) and those who underwent surgical ablation (6 out of 47). In the majority of patients arrhythmia returned during follow up, but most patients experienced only occasional episodes of it. The symptoms associated with arrhythmia were therefore not as burdensome and most patients reported significantly improved quality of life. Since surgical ablation is more expensive but not better than catheter ablation three years after the treatment, we conclude that catheter ablation should be the recommended treatment for patients with this difficult to treat heart rhythm abnormality.
These results suggest that symptomatic long lasting atrial fibrillation patients should be considered for ablation as significant arrhythmia burden reduction and consequent improvement in quality of life can be achieved after a single ablation procedure in ~ 60% of patients at 3 years.REC name
London - London Bridge Research Ethics Committee
REC reference
19/LO/1595
Date of REC Opinion
19 Dec 2019
REC opinion
Further Information Favourable Opinion