Surgery vs. Drugs for Irregular Heartbeat
But safety issues may still make medications better choice for many patients, experts say
More than two-thirds of the 61 patients who started on medications took the drug flecainide, while another 25 percent took propafenone.
Sixty-six patients were assigned to get surgery as their first treatment, though one didn't get the procedure.
Over the next two years, 44 patients (72 percent) in the medication group and 36 patients (54 percent) in the surgery group experienced an irregular and rapid heartbeat that lasted longer than 30 seconds. Surgery reduced the chances of having one of these episodes by 44 percent. Both groups experienced similar improvements in their quality of life.
But researchers said there are some important caveats to understand about surgery. First, they said, it's not usually a permanent solution, and second, it's not without serious risks.
"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.