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Major breakthrough in AF ablation

A study published recently in the Journal of the American College of Cardiology will change a way of thinking about the disease atrial fibrillation. And it’s about time. One word describes AF therapy in the past decade: plateau. Ten years have passed and we have no new drugs and no real breakthrough in AF ablation.

Until now.

ARREST-AF was an ablation study that showed success rates after the procedure can be increased five-fold. That’s not a typo. But it’s also not the most important lesson from the trial.

ARREST-AF will be influential, paradigm-changing even, because it further confirms that AF, in most cases, is a diffuse disease of the atria. Successful treatment, therefore, requires more than just a focal solution, such as pulmonary vein isolation. It requires other things.

An analogy comes in interventional cardiology. Here, my colleagues place stents (metal cages) into discrete areas of narrowing. That process improves the physics of flow at that point but does nothing for the systemic disease of atherosclerosis. This is why stents don’t prevent heart attacks or death in chronic arterial disease: because a focal solution doesn’t address the widespread disease.

So what did the AF researchers do? What were their findings? How will it change the paradigm of treating AF?

I wrote about ARREST-AF over at|Medscape Cardiology.

Here is the title and the link: ARREST-AF: A Turning Point in AF Care


Reference: ARREST AF:

Note that Medscape requires that you register with an email.

5 replies on “Major breakthrough in AF ablation”

Articles like this just make me mad!
Yes these things help with the fat people but how about the ones that are not fat?
You would think they would at least mention the one procedure that cures A-Fib 96+% of the time! Cured me on August 1st 2012 spread the word!
Dr John Mandrola you sir are wrong, I weigh in at 240 and I have not had ONE episode since the day of surgery!
I do agree I need to loose weight and I’m trying to do just that, but please comment about the 96% success of Dr. Sirak’s patients!

Congratulations on your success. More power to you.

I presume you had the Five-Box procedure? Paroxysmal? Persistent? How was your recovery period following the procedure?

Actually, not-quite 2 1/2 years is not a lot of time in the grand scheme of life. I wonder what your age is. Might you see another 25 years?
Your heart is scarred from the procedure, but you still have plenty of active atrial tissue that might be remodelling as we speak. The point is, remove the cause(s) of the original AF, and you likely won’t be faced with a recurrence. It’s progressive, unless you address the cause(s).

I see mixed messages. You’re angry, but you say you’re 240 lbs. You’d have to be seven feet tall to just make a normal body mass index. Of course, it all depends on the composition of that mass. I’m sure Arnold’s BMI is not normal, but that’s not fat.

Great post Dr. M. I wish more doctors would have the huevos to tell patients to drop some pounds. I have seen 9 cardiologists/eps in the last 10 years, some with world class reputations, and not one gave me grief about my weight, even though i was hovering between BMIs at the threshold of the obesity threshold. I am working on it and know from your posts it will make a difference. My advice to doctors is to grow a pair. My statement to patients who are offended by advice like this is to get a thicker skin. jeff.

This is good for those whose lifestyles are not the best and kudos to those who change them for the better. Overall healthy benefits.

There is still something missing of course for those of us who are slender, exercise, and eat very healthily.

That said, I believe there are breakthroughs that can be found in other areas, such as earthing. The AF problem is an electrical problem, so what if restoring our electrical balance is a huge key. I am in the process of purchasing some grounding or earthing equipment to try this.

Two other factors are important from this article, that aren’t new, and that’s hypertension and sleep apnea. I do have both, the bp is controlled, but i am allergic to all the cpap masks (my nasal & throat tissues swell shut) and cannot afford the mouth guard. All i use are breatherights, which do help, but not enough. HOWEVER, I am not sure which comes first, the chicken or the egg, as I have sometimes suspected that the AF causes the apnea. Maybe grounding will solve that problem too (the apnea)

What was encouraging from the article is that the structural makeup of the heart changed, regenerated & healed in the examples given. Yay for that, that has always been my long term goal.

All the best. Good to keep looking at this issue as it has NOT been understood. Thanks.

Well, my weight and BP are both normal, my diet is low fat, no alcohol or caffeine, total cholesterol about 170, and I have been exercising at the AHA recommended rate for the last 46 of my 54 years. And I have paroxysmal atrial flutter (ablated) and afib (controlled with anti arrhythmic medication for the last 9 months.) Is there any good news in the ARREST study for a patient like me?

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