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In a careful study of symptomatic and asymptomatic recurrences of atrial fibrillation (AF) after catheter ablation, Verma and colleagues find that fewer patients experience symptomatic AF after ablation, but most patients still experience AF, albeit of a decreased frequency and duration. Because ablation has never been studied in a randomized blinded fashion, we cannot know whether patients experience fewer symptoms after ablation because subjective symptoms frequently decrease following a procedure or whether the ablation itself was beneficial.
Furthermore, the risk for stroke remains when AF persists, whether AF is symptomatic or not. The clinical benefit on survival and morbidity of this invasive procedure, which has substantial procedural risks, remains to be established.
Redberg RF. Clinical Benefit of Catheter Ablation for Atrial FibrillationComment on “Discerning the Incidence of Symptomatic and Asymptomatic Episodes of Atrial Fibrillation Before and After Catheter Ablation (DISCERN AF)”. JAMA Intern Med. 2013;173(2):157. doi:10.1001/jamainternmed.2013.2308