Minimally invasive heart surgery may be a better first-line treatment than medication for people with advanced atrial fibrillation, according to a large international clinical trial led by researchers at the University of British Columbia.
Atrial fibrillation (AFib) is a common and serious heart rhythm disorder that affects more than 50 million people worldwide, including approximately 1 million Canadians. The heart beats irregularly, which can cause symptoms such as fatigue, shortness of breath, and palpitations, and significantly increases the risk of stroke, heart failure, and early death.
For decades, most patients with atrial fibrillation first received drug therapy. Procedures such as catheter ablation, a minimally invasive technique used to correct erroneous electrical signals within the heart, have typically been reserved for patients whose symptoms persist despite drug therapy. Although recent studies suggest that ablation may be a more effective initial treatment for early-stage disease, it is also unclear whether this applies to patients with more advanced disease, who tend to be older, have more underlying conditions, and face a higher overall risk.
Published in New England Medical Journala new study shows that starting with ablation may lead to better outcomes for patients with advanced atrial fibrillation.
Traditionally, we have taken a step-by-step approach, starting with medication and then moving to treatment. This trial shows that even in patients with more advanced atrial fibrillation, early intervention with ablation can provide significant benefit and better control of the disease. ”
Dr. Jason Andrade, Clinical Professor, UBC School of Medicine, Research Fellow, Center for Cardiovascular Innovation
Another way to treat the heart
The study focused on patients with persistent atrial fibrillation, a more severe form in which the abnormal rhythm lasts longer and is more difficult to treat.
Researchers randomly assigned patients to receive catheter ablation or standard antiarrhythmic drug therapy as initial treatment.
During catheter ablation, the doctor guides a thin, flexible tube through the blood vessels and into the heart. Once in place, the area of heart tissue responsible for generating and maintaining abnormal electrical signals is removed.
In this study, the researchers used a new technique called pulsed field ablation. It delivers short bursts of electrical energy to precisely target heart tissue.
“You can think of it as resetting the heart’s electrical system,” Dr. Andrade says. “Instead of using heat or freezing, this approach uses carefully controlled pulses to block abnormal signals and minimize damage to surrounding tissue.”
After one year, patients who underwent ablation were significantly more likely to have no abnormal heart rhythms than those who started medication. The overall risk of serious adverse events was similar between the two groups.
“Patients with more advanced atrial fibrillation are inherently more complex,” Dr. Andrade said. “Even in this high-risk group, it may be possible to better control the condition by starting with ablation.”
10 years of rebuilding global care
The findings are based on more than a decade of research led by Dr. Andrade and his team, which has helped transform the way atrial fibrillation is treated around the world.
An early landmark trial by this group demonstrated that catheter ablation can be used as a first-line treatment for patients with early-stage atrial fibrillation. Additionally, these studies demonstrated for the first time that catheter ablation is a disease-modifying therapy and significantly slows disease progression.
These discoveries are helping to change clinical practice globally, with more physicians offering ablation earlier in a patient’s treatment.
Together, this research program has redefined how atrial fibrillation is treated across the entire spectrum, from early stages to more advanced stages, and provided patients and clinicians with clear guidance on when to consider ablation.
“Our goal is to provide patients and clinicians with the evidence they need to make the decisions that are best for each individual,” said Dr. Andrade. “This study fills an important gap for a group of patients for whom the answers were not clear-cut.”
sauce:
University of British Columbia
Reference magazines:
Wazni, O.M.; Others. (2026). Pulsed-field ablation as initial treatment for persistent atrial fibrillation. New England Medical Journal. DOI: 10.1056/NEJMoa2600929. https://www.nejm.org/doi/full/10.1056/NEJMoa2600929
