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Surgery vs. Drugs for Irregular Heartbeat

But safety issues may still make medications better choice for many patients, experts say


"Ablation was better than medications as a first-line therapy, but by two years, about 50 percent of the people who had undergone one ablation had a recurrence of their symptoms," said study author Dr. Carlos Morillo, a professor of cardiology at McMaster University in Ontario, Canada.

And he noted, there's a 20 percent to 30 percent chance that an ablation may have to be redone because doctors didn't zap all the right areas the first time around.

"We make people less symptomatic. They have less episodes, and we think the progression of the disease is delayed," Morillo said.

But the surgery group had more serious negative events than the drug group. Overall, one in 11 patients who had the ablation had a serious complication. The most frequent problem was cardiac tamponade, caused when surgeons burned a hole through the wall of the heart.

Calkins said cardiac tamponade is a medical emergency, and although no patients died from it in this study, it can be life threatening. Previous studies have found that it's the most common cause of death in patients who undergo catheter ablation.

"There's no pressure sensor on currently available catheters to tell you how hard you're pushing. So if you push too hard, you poke a hole in the heart," Calkins said. "Then blood leaks out into the sac around the heart," he explained.

That buildup of blood squeezes the heart, causing blood pressure to drop. "If untreated, you could be dead in 15 minutes," Calkins said.

A study published in 2013 in the journal Circulation, which reviewed the outcomes of nearly 94,000 catheter ablation procedures, found an overall complication rate of just over 6 percent. About one in 217 patients who had ablations died in the hospital after their procedures.

For that reason, Calkins said he still thinks it's wiser to start with medication. If drugs don't work, he said, patients can feel good stepping up to surgery, which has become safer as doctors get more experience and have better tools to work with.

"For most people, I think that's the better strategy," Calkins said.


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