American Heart Journal
Volume 152, Issue 2 , Page e19, August 2006

Response to Letter to the Editor

Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH

Article Outline

 

The letter by Dr Jolobe correctly emphasizes the importance of a critical look at the putative success rates of various atrial fibrillation therapies. There are several points to keep in perspective. A major thesis of our article1 was that presently available drugs are not as efficacious as we would like. In fact, the more rigorous the follow-up on whatever therapy (antiarrhythmic drugs, ablation), the incidence of asymptomatic or silent atrial fibrillation is considerable.2, 3 Another part of this perspective, emphasized in our article, is that recurrence of atrial fibrillation is not failure per se. It is the frequency of recurrence and the seriousness of symptoms during recurrence that is the measure of efficacy. The First Antiarrhythmic Drug Study, which was part of the AFFIRM trial, demonstrated that after recurrence of atrial fibrillation, if one were willing to cardiovert the rhythm and either keep the patient on the same antiarrhythmic drug or change to a different antiarrhythmic drug if indicated, at the end of 1 year, roughly 80% of patients were in sinus rhythm.4 That may not be a bad strategy if rhythm control is the clinical objective, and it is particularly worth emphasizing, as recent publications have shown, that the recurrence rate of asymptomatic atrial fibrillation is remarkably high after putative cures of atrial fibrillation with either catheter ablation or the surgical Maze procedure, reported as high as 37%.3 In the end, Dr Jolobe's comments serve further to emphasize the point that there is a great unmet need.

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References 

  1. Waldo AL. A perspective on antiarrhythmic drug therapy to treat atrial fibrillation: there remains an unmet need. Am Heart J. 2006;151:771–778
  2. Rho RW, Page RL. Asymptomatic atrial fibrillation. Prog Cardiovasc Dis. 2005;48:79–87
  3. Hindricks G, Piorkowski L, Tanner H, et al. Perception of atrial fibrillation before and after radiofrequency catheter ablation: relevance of asymptomatic arrhythmia recurrence. Circulation. 2005;112:307–313
  4. The AFFIRM First Antiarrhythmic Drug Substudy Investigators . Maintenance of sinus rhythm in patients with atrial fibrillation. J Am Coll Cardiol. 2003;432:20–29

PII: S0002-8703(06)00437-6

doi:10.1016/j.ahj.2006.05.003

American Heart Journal
Volume 152, Issue 2 , Page e19, August 2006

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