Studies of RFA for treatment of atrial fibrillation report higher efficacy rates than do studies of AAD therapy and a lower rate of complications
BACKGROUND Although radiofrequency catheter ablation ( RFA ) has evolved from an experimental procedure to an important treatment option for atrial fibrillation , the relative safety and efficacy of catheter ablation relative to that of antiarrhythmic drug ( AAD ) therapy has not been established .
Complication Rates Associated With Pacemaker or Implantable Cardioverter-Defibrillator Generator Replacements and Upgrade Procedures: Results From the REPLACE Registry
Background — Prospect i ve studies defining the risk associated with  pacemaker or implantable cardioverter-defibrillator replacement surgeries do not exist . These procedures are generally considered low risk despite results from recent retrospective series reporting higher rates . Methods and Results — We prospect ively assessed predefined procedure-related complication rates associated with  elective pacemaker or implantable cardioverter-defibrillator generator replacements  over 6 months of follow-up . Two groups were studied : those without ( cohort 1 ) and those with ( cohort 2 ) a planned transvenous lead addition for replacement or up grade to a device capable of additional therapies . Complications were adjudicated by an independent events committee . Seventy-two US academic and private practice centers participated .  Major complications occurred in 4.0 % ( 95 % confidence interval , 2.9 to 5.4 ) of 1031 cohort 1 patients and 15.3 % ( 95 % confidence interval , 12.7 to 18.1 ) of 713 cohort 2 patients . In both cohorts , major complications were higher with implantable cardioverter-defibrillator compared with pacemaker generator replacements .  Complications were highest in patients who had an up grade to or a revised cardiac resynchronization therapy device ( 18.7 % ; 95 % confidence interval , 15.1 to 22.6 ) . No periprocedural deaths occurred in either cohort , although 8 later procedure-related deaths occurred in cohort 2 . The 6-month infection rates were 1.4 % ( 95 % confidence interval , 0.7 to 2.3 ) and 1.1 % ( 95 % confidence interval , 0.5 to 2.2 ) for cohorts 1 and 2 , respectively . Conclusions — Pacemaker and implantable cardioverter-defibrillator generator replacements are associated with a notable complication risk , particularly those with lead additions . These data support careful decision making before device replacement , when managing device advisories , and when considering up grade s to more complex systems . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00395447
Studies of RFA for treatment of atrial fibrillation report higher efficacy rates than do studies of AAD therapy and a lower rate of complications
BACKGROUND Although radiofrequency catheter ablation ( RFA ) has evolved from an experimental procedure to an important treatment option for atrial fibrillation , the relative safety and efficacy of catheter ablation relative to that of antiarrhythmic drug ( AAD ) therapy has not been established .