Comparing Cardiac Catheter Ablation Success During Paroxysmal Versus Persistent and Long-Standing Persistent Afib

When we diagnose patients with Afib, we must discuss the difference between varying stages of the condition, as this can be significant in the decision-making continuum. Before we get into the success rates of cardiac catheter ablation between stages of Afib, it is essential that we define the progression of the condition and how it manifests in the patient.

In most cases, Afib begins as occasional or paroxysmal. This broadly means patients experience a couple of episodes, lasting for 30 seconds or more but ending rapidly (within seconds, hours, or even a couple of days), in a week. Because it is occasional, many patients wait too long to see an electrophysiologist. Or they visit their primary care physician or general cardiologist for an EKG. Yet often, this EKG shows nothing wrong because paroxysmal Afib episodes are irregular and unpredictable. EKGs only offer a snapshot of the heart during the office visit. The result is that many patients are sent home without a definitive diagnosis.

Persistent Afib is the typical next-stage manifestation of untreated paroxysmal Afib. Persistent Afib is defined as episodes that last a week or more and up to 12 months, during which patients can have varying symptoms. Typically, a patient will know that the heart is an Afib, and cardioversion may be required to end the episode.

Longstanding persistent Afib is an episode that has continued unabated for 12 months or more- this was once known as permanent Afib. Typically, standard therapies such as cardioversion and medication will fail to return the heart to sinus rhythm, and even procedural intervention like cardiac catheter ablation may not be successful.

The Importance of Treating Afib Early

To get to the crux of our discussion, we need to evaluate the effectiveness of cardiac catheter ablation, amongst other treatments, for the varying stages of Afib. When we do so, we quickly realize that treating it at its earlier stages is essential for reversing the condition. As a rule of thumb, cardiac catheter ablation is effective in 70 to 80% of well-qualified patients with paroxysmal Afib. This success rate drops to about 50 to 60% in patients with persistent Afib. However, patients experiencing longstanding persistent Afib may not benefit from catheter ablation at all.

Getting an Appropriate Diagnosis

As mentioned above, a proper diagnosis is one of the biggest challenges with early-stage Afib. One of the impediments to this is a need for appropriate diagnostic technology at the primary care level. Patients who visit their primary care physician, knowing they have an arrhythmia, often do not get a proper diagnosis because most PCPs do not have the advanced diagnostic tools that electrophysiologists do. This can lead to a delay in diagnosis and treatment, making any intervention less effective. As such, if you have visited your primary care physician or cardiologist and received an all-clear from your EKG but still feel like you have heart rhythm abnormalities, you should see an electrophysiologist. For example, we use longer-term EKG monitoring through Holter monitors, event monitors, and loop recorders to get heart rate information over an extended period. This dramatically increases the chance that we catch a paroxysmal Afib episode earlier. Further, if it is a particularly challenging diagnosis, we can use a minimally invasive EP study to find or even induce Afib, with the option of treating it during the same procedure if appropriate.

The Bottom Line

As you can see, the success rates of interventions decrease as the condition worsens and becomes more persistent. While Afib is not imminently dangerous unless the patient has other underlying heart disorders, it can lead to far more severe concerns, such as five times increased risk of stroke and heart attack and a much-increased risk of long-term heart failure.

And this long-term risk is precisely why we want to treat Afib before it becomes persistent and adds strain to the heart, potentially reducing its ability to pump blood effectively in the future. Yes, we can significantly reduce the risk of stroke through anticoagulant medication and/or procedural left atrial appendage occlusion. However, we have yet to find a consistent solution for later-stage Afib.

As they say, an ounce of prevention is worth a pound of cure, and Afib is the same. While you may be able to live with and around paroxysmal Afib, it is not ideal to do so for the reasons stated above. If you live in Tampa or Saint Petersburg, we encourage you to schedule a consultation with Dr. Tordini to understand your Afib treatment options.

Dr. Tordini is a part of Florida Medical Clinic Orlando Health