New clinical trials in the cardiology world from the American College of Cardiology

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HARTFORD – Cardiology specialists from around the world gathered in San Diego, California to hear about the results of new clinical trials that were just released.  One of them has some important information for patients with heart failure and atrial fibrillation.

Heart failure is a common disease in the United States where the heart cannot pump well enough to meet the body’s needs.  These likely either had a heart attack or had longstanding hypertension which caused the heart to fail.  People have shortness of breath and ankle swelling as a result and it could be deadly.  In atrial fibrillation, the heart rhythm in top of the heart called the atria is messed up it reduces the efficiency of the heart pumping.  Since the top part of the heart is not pumping well you could get a blood clot in the heart that can dislodge and cause a stroke.   Having both heart failure and atrial fibrillation is a double whammy which makes it even harder on your heart.

The trial was called the AATAC trial (pronounced ATTACK) where people with mild to moderate heart failure and an arrhythmia called atrial fibrillation were randomized to use the best antiarrhythmic drug named amiodarone or undergo a procedure called ablation.  In ablation, a cardiologist puts a catheter into a vein and moves it into the heart where they find the exact area of the atria causing atrial fibrillation and zaps it with intense heat destroying it.  In some people, they can stop them from having atrial fibrillation altogether rather than just suppressing the arrhythmia with amiodarone.  This trial directly compared these two treatments head to head and ablation was the winner.  In 203 patients, the risk of having a recurrence of atrial fibrillation was 2 ½ time higher with amiodarone and the need for hospitalizations due to low blood pressure or heart failure was 45% lower.

In previous studies, in patients with heart failure and atrial fibrillation only amiodarone and dofetilide were shown to be safe enough to use.  So people only had two options available for rhythm control.  Now they have three options and this third option, ablation, may not just reduce the symptoms associated with atrial fibrillation like lightheadedness and palpitations in your chest, but it can help these people with heart failure pump blood better and have fewer hospitalizations.  Patients with both of these diseases who aren’t doing well on amiodarone can talk with their cardiologists and see if ablation is right for them.  For example, in the study patients had to have a type of atrial fibrillation where we know ablation works well in patients without heart failure so people with other types of atrial fibrillation may not have the same degree of benefit.

Michael White, Dept. of Pharmacy Practice, UConn School of Pharmacy.