In this article, Dr Ma Changsheng shares about the innovations to help atrial fibrillation patients improve outcomes through early intervention and better management of the disease state.
Numbers tell the story. In Asia Pacific, Atrial Fibrillation (AFib) affects an estimated 16 million and is on the rise with 1.4 million new cases identified each year. A recent report in the region highlighted that 1 in 5 Chinese adults have an estimated lifetime risk for AFib. By 2050, the same report found that the number of AFib patients is projected to increase to an estimated 72 million, accumulating to twice as many AFib patients in APAC as in Europe and North America combined.
Why will AFib affect more Asia Pacific patients in the future? Research points to a rapidly aging population and lifestyle risk factors, such as hypertension, obesity, metabolic syndrome, and diabetes.2 With this, the rates for strokes and hospitalizations are expected to increase, imposing a 1.8 to 5.6 times increase in healthcare costs every decade across Asia Pacific.
A Call for Early Intervention & Innovation
Research has shown that progression of AFib is associated with increased risk of clinical adverse events. As such, early intervention can play a significant role in improving patient outcomes.
As the medical field has deepened our understanding of this disease state, we have been able to innovate and advance new solutions. Cardiac ablation procedures have increasingly set the stage as a standard of care for patients as an alternative to drug therapy.
Results from the Atrial Fibrillation Progression Trial (ATTEST) have shown that catheter ablation is more effective than drug therapy in delaying arrhythmia progression. Patients with intermittent AFib treatment using catheter ablation were almost 10 times less likely to develop persistent AFib than those on standard antiarrhythmic drugs (AADs) at three years follow-up.
Additionally, patients aged 65 and above were found to be four times more likely to progress to persistent AFib than their younger counterparts (60-64 years old), suggesting that treatment at an early stage is crucial to delay or prevent disease progression.
Improving Patient Outcomes Through AFib Management
Recognizing the value and benefits of catheter ablation, technological advances over the past decade have focused on reducing procedure duration and improving safety. One area that has evolved over the years is imaging modalities with significant improvements made in navigation, lesion formation and overall procedural safety.
However, common techniques such as fluoroscopy, CT, MRI and transoesophageal echocardiography still have several limitations. For instance, fluoroscopic imaging offers limited insights into endocardial anatomy and localization of the catheter, while CT and MRI imaging do not provide real-time visualization or monitoring of complications.
In this regard, intracardiac echocardiography (ICE) has been able to address many of the limitations of other imaging technologies, providing a unique ability to image the left atrium in real-time throughout the course of the procedure and to identify structures important for ablation.
Another key point to note is that ICE significantly reduces fluoroscopy, which is crucial not only for patient safety, but also in eliminating hazardous exposure to radiation that electrophysiologists experience daily. A study involving 60 AFib patients randomized to electroanatomical mapping (EAM) or ICE plus EAM showed a 22 percent reduction in fluoroscopy time and 125 Gy/cm2 fall in fluoroscopy dose with the latter.
Finally, when using compatible EAM systems, healthcare professionals can reconstruct a three-dimensional imaging of the left atrium, enabling greater precision and safety. Three-Dimensional Transseptal Puncture (TSP) based on ICE provides direct visualization of the TSP needle in the 3D geometry of the right atrium, which allows real-time navigation of the assembly and successful TSP. By deploying this technique, interventional electrophysiology procedures can be performed with almost zero x-ray exposure, which prevents both patients and physicians from radiation injury.
With a growing body of evidence showing that the integration of ICE into ablation workflows has brought significant improvements to surgical outcomes, healthcare professionals like myself was able to explore how innovation can help improve patient outcomes for Atrial Fibrillation and play a critical role in reducing the burden in Asia Pacific.
- Biermann, J., Bode, C., & Asbach, S. (2012). Intracardiac Echocardiography during Catheter-Based Ablation of Atrial Fibrillation. Cardiology Research and Practice, 2012(), 1–8.
- Kuck KH. et al. (2021). Catheter ablation or medical therapy to delay progression of atrial fibrillation: the randomized controlled atrial fibrillation progression trial (ATTEST). European Society of Cardiology. 2021; 23,362–369
- Biosense Webster (2019) Beyond the Burden: The Impact of Atrial Fibrillation in Asia Pacific. Retrieved from: https://www.jnjmedicaldevices.com/sites/default/files/user_uploaded_assets/pdf_assets/2019-10/BeyondtheBurdenReport.pdf
- Brooks A.G. et al. (2013). Accuracy and clinical outcomes of CT image integration with Carto-Sound compared to electro-anatomical mapping for atrial fibrillation ablation: a randomized controlled study. International Journal of Cardiology. 2013;168(3):2774-82.
- Epstein L.M. (2000). The utility of intracardiac echocardiography in interventional electrophysiology. Current Cardiology Reports. 2000;2:329-34.
- Global Burden of Disease Collaborative Network. (2017). Global Burden of Disease Study 2017 Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME) Retrieved from http://ghdx.healthdata.org/gbd-results-tool.
- Kuck KH. et al. (2019) Catheter ablation delays progression of atrial fibrillation from paroxysmal to persistent atrial fibrillation. ESC Late-breaking Science 2019. Paris, France. August 31, 2019.
- Kuwahara T. (2015). Intracardiac echocardiography in catheter ablation for atrial fibrillation: it is better to see what you are doing? Journal of Atrial Fibrillation. 2015;7(6):1215.
- Ogawa H., An Y., Ikeda S., et al. Progression From Paroxysmal to Sustained Atrial Fibrillation Is Associated With Increased Adverse Events. Stroke. 2018;49(10):2301-2308.
- Wong, C. X., Brown, A., Tse, H-F., et al. (2017). Epidemiology of Atrial Fibrillation: The Australian and Asia-Pacific Perspective. Heart, Lung and Circulation, (), S1443950617304845–.
About the Author
Dr Ma Changsheng is the Director of the Cardiology Department at Beijing Anzhen Hospital as well as the Professor of Medicine and Chair of Faculty of Cardiovascular Disease at Capital Medical University. He treats over 3,000 AFib cases every year and has achieved an ICE penetration rate of more than 60 per cent. He has published over 730 articles and is on the editorial board of more than 30 local and international journals.