Repeat Paroxysmal AF Patients…what does this mean for AF in 2010? February 17, 2010

 As I begin this year assisting with repeat ablations on atrial fibrillation (AF) patients who had AF procedures in 2009 and 2008 (and 2007…), I find myself wondering what will be ‘new’ in AF ablation this year.  Paroxysmal AF patients – the ones I typically see once and never again – are becoming fewer and fewer.  Much like the well of coronary patients who dried up a couple of years ago, post-DES, the number of AF patients that can actually be treated ablatively seems, in my very narrow world view, to be dwindling.

 I spend a lot of my working hours wishing that AF (and for that matter, VT) ablation had the cure rate that AVNRT and the other “solved” arrhythmias have.  Independent of the widely-variable published success rates for AF, the AF patients are the ones I see over and over again for procedures, often with the same results.  And I know this observation is not limited simply to where I work.

 So then, what will it be for AF in 2010? Will CFAE sites be shown to be the “answer” for AF? What about AF “nests?” Will it be a new ablation technology, such as the laser balloon? Will it be the surgeons assisting us in the relatively new “hybrid” procedures in the OR that allow us to treat this arrhythmia in a more permanent fashion? Or will we ever have a long-term solution for persistent and permanent AF other than AV node ablation? (more…)