Conclusions
The literature on ablation for AF has many of the features of clinical research in the era preceding evidence-based medicine and randomised trials. Many studies emanate from single centres, involve low patient numbers, and fail to provide adequate statistical analysis, including intention to treat analysis and evaluation of statistical power. As was the case with Maze operations, new procedures are continually proposed without completing satisfactory evaluations of previously proposed procedures. Very worrisome is that most studies have not involved neutral committees for the recording and supervision of severe complications.
The belief that AF ablation now represents a standard or, indeed, first-line treatment is excessively optimistic and may reflect occupational and economic factors encouraging mechanistic invasive procedures.
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References
Pacifico A, Henry PD (2004) Ablation for atrial fibrillation: are cures really achieved? J Am Coll Cardiol 43:1940–1942
Kannel WB, Wolf PA, Benjamin EJ et al (1998) Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 82(suppl 8A):2N–9N
Wattigney WA, Mensah GA, Croft JB (2003) Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999. Implication for primary prevention. Circulation 108:711–716
Pappone C, Oreto G, Rosanio S et al (2001) Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation — Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 104:2539–2544
Maggioni AP, Latini R, Carson PE et al (2005) Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the valsartan heart failure trial (Val-Heft). Am Heart J 149:548–557
Young-Xu Y, Jabbour S, Goldberg R et al (2003) Usefulness of statin drugs in protecting against atrial fibrillation in patients with coronary artery disease. Am J Cardiol 92:1379–1383
Ciaroni S, Cuenoud L, Bloch A (2000) Clinical study to investigate the predictive parameters for the onset of atrial fibrillation in patients with essential hypertension. Am Heart J 139:814–819
Nichol G, McAllister F, Laupacis A et al (2002) Meta-analysis of randomised controlled trials of the effectiveness of antiarrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation. Heart 87:535–543
Ferguson JJ, Califf RM, Antman EM et al (2004) Enoxaparin vs unfractioned heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. JAMA 292:45–54
Pappone C, Rosanio S, Augello G et al (2003) Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation — Outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol 42:185–197
Pacifico A, Henry PD (1996) Class I or Class III agents for atrial fibrillation: are we asking the right question? Pacing Clin Electrophysiol 26:1613–1619
Waldo AL, Camm AJ, deRuyter H et al for the SWORD Investigators (2003). Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. Lancet 348:6–11
Savelieva I, Camm AJ (2000) Clinical relevance of silent atrial fibrillation: prevalence, prognosis, quality of life, and management. J Interv Card Electrophysiol 4:369–382
Israel CW, Grïsefeld G, Ehrlich JR et al (2004) Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device. J Am Coll Cardiol 43:47–52
Strickberger SA, Ip J, Saksena S et al (2005) Relationship between atrial tachyarrhythmias and symptoms. Heart Rhythm 2:125–131
Cook RC, Alscher KT, Hsiang YN (2003) A debate on the value and necessity of clinical trials in s urgery. Am J Surg 185:305–310
Wingerchuk DM, Noseworthy JH (2002) Randomised controlled trials to assess therapies of multiple sclerosis. Neurology 58:S40–S48
Saririan M, Eisenberg M J (2003) Myocardial laser revascularization for the treatment of end-stage coronary artery disease. J Am Coll Cardiol 41:173–183
Grines C, Rubanyi GM, Kleiman NS et al (2003) Angiogenic therapy with adenovirus 5 fibroblast growth factor-4 (Ad5FGF-4): a new option for the treatment of coronary artery disease. Am J Cardiol 92:21N–31N
Gaita F, Riccardi R, Calïs L et al (1998) Atrial mapping and radiofrequency catheter ablation in patients with idiopathic atrial fibrillation — Electrophysiological findings and ablation results. Circulation 97:2136–2145
Bertaglia E, Stabile G (2005) Catheter Ablation for the Cure of Atrial Fibrillation (CACAF). Late-Braking Clinical Trials II, March 8, 2005. 54th Annual Scientific Session of the American College of Cardiology, Orlando, Florida
Saad EB, Rossillo A, Saad CP et al (2003) Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation — Functional characterization, evolution, and influence of the ablation strategy. Circulation 108:3102–3107
Ezekowitz MD, James KE, Nazarian SM et al (1995) Silent cerebral infarction in patients with nonrheumatic atrial fibrillation. The Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillatiion Investigators. Circulation 92:2178–2182
Sabatini T, Frisoni GB, Barbisoni P et al (2000) Atrial fibrillation and cognitive disorders in older people. J Am Geriatr Soc 48:387–390
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Pacifico, A., Henry, P.D. (2006). Atrial Fibrillation Should Be Considered a First-Line Therapy — Or Not?. In: Raviele, A. (eds) Cardiac Arrhythmias 2005. Springer, Milano. https://doi.org/10.1007/88-470-0371-7_33
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