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Welcome to the first issue of a new year – our 11th year of publication! Catheter ablation for atrial fibrillation has become hugely popular since Profs. Haissaguerre and Jais (Bordeaux group) discovered in 1998 that the majority of rogue cells triggering AF were located in the pulmonary veins – at least in the case of paroxysmal (intermittent) AF. Since then, tens of thousands of catheter ablations have been performed and the technology involved in doing them has advanced with astonishing speed. Immediate and even one year success rates of 80% or higher are now reported from high-volume centers (2 or more procedures a day). What has been lacking until now is evidence concerning the longevity of these procedures. Our 2009 Ablation/Maze Survey evaluated the long-term prognosis for afibbers who had undergone one or more catheter ablation procedures for the purpose of curing their AF. Eighty-six percent of those who experienced no AF episodes during the index period (the last 6 months of the 12 months following their last procedure) were still AF-free without the use of antiarrhythmics 5 years later. This excellent success rate was, unfortunately, reduced to 33% if AF episodes had been experienced during the index period. Australian researchers recently confirmed the importance of having no AF episodes by the end of the first 12 months following the last procedure and quoted a success rate (with or without antiarrhythmics) of 80% at 4 years for a group of highly symptomatic paroxysmal afibbers. Success rates quoted by the Bordeaux group are 81% at 2 years and 63% at 5 years for a group of paroxysmal, persistent and permanent afibbers having undergone a median of two procedures. However, the failure criterion used by the Bordeaux group (one episode of AF, atrial flutter or atrial tachycardia lasting more than 30 seconds anytime after the completion of the ablation) is, in my opinion, unrealistically strict. Also in this issue we report that Polish researchers confirm my 2003 hypothesis that aldosterone is a major player in AF and that its detrimental effect can largely be counteracted by treatment with spironolactone or eplerenone. Japanese researchers have found that corticosteroid treatment immediately following ablation markedly reduces the risk of recurrence, and finally, a group of university-associated American cardiologists reports that Lovaza (a synthetic fish oil derivative) is ineffective in preventing AF recurrence.
All this and more in the first 2011 blockbuster issue!
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