More research funding into keyhole surgery for atrial fibrillation

A research project comparing two types of surgical techniques for patients with long standing persistent atrial fibrillation (LSPAF) has been awarded further funding to determine the long-term effects in patients.

The project, led by Dr Tom Wong, a cardiologist at Royal Brompton & Harefield NHS Foundation Trust, has been funded by the National Institute for Health Research (NIHR) through their Research for Patient Benefit (RfPB) programme which funds research projects that increase the effectiveness of NHS services, provide value for money and benefit patients.

What is atrial fibrillation?

Atrial fibrillation (AF) is a common abnormal heart rhythm that happens when electrical impulses fire off from different places in the heart in a disorganised way. This causes the heart to twitch, and is felt as an irregular heartbeat or pulse. AF can lead to frequent hospital admissions, which can have a substantial impact on quality of life. 

The longer a person has AF, the more difficult it is to go back into normal heart rhythm. Those who have continuous AF for longer than a year are described as having longstanding persistent AF (LSPAF). This is the most challenging type of AF to treat and accounts for a large proportion of all AF patients. 

However, existing treatments used for patients with AF do not work as well in patients with LSPAF and have many side effects. 

Instead, patients with LSPAF are typically offered a procedure known as catheter ablation which involves putting a flexible thin tube (catheter) through a blood vessel in the groin and up into the heart. This procedure has low success rates in returning patients to normal rhythm. 

More recently, patients with LSPAF have been offered thoracoscopic surgical ablation, which is keyhole surgery where small incisions are made in the chest wall. A camera, small rod and clamp are then used to block electrical signals over the surface of the heart.

Dr Wong’s previous research showed that of the two procedures, thoracoscopic surgical ablation is better for patients with LSPAF compared with catheter ablation, over the course of a year.

However, the team have no data on how well these patients do beyond one year which is what Dr Wong and his team aim to look at next. 

What’s next?

With the additional funding Dr Wong’s team will monitor patients from the original research study who already have a small device implanted under the skin to measure their heartbeat. 

This heartbeat monitor has a battery life of around 3 years, which will allow the research team to collect data so they can determine whether patients have had a recurrence of the abnormal rhythm.

The first stage of the project involves the monthly download of information from the implanted device; the second stage will involve two hospital visits to give blood and answer questionnaires, two and three year’s after the procedure.

This additional data will allow the research team to determine conclusively if thoracoscopic surgical ablation is better for patients with LSPAF compared with catheter ablation in the long term.

The research team hope that the results from the study will help to inform clinical guidelines, both nationally and internationally) on whether surgical ablation has better outcomes for patients in the long term compared to catheter ablation.

Dr Boyalla who led the funding application was grateful for the support she received:

“The success of this funding is the result of concentrated effort from Dr Tom Wong, the research team, the research office at the Trust and the NIHR Research Design Service.”

To find out more about this project or any of our other research please contact us.