Many patients present to Cardiology clinics with symptoms of palpitations; the awareness of their heart beat. Palpitations and associated symptoms (such as lethargy, effort intolerance, breathlessness, lightheadedness and chest discomfort) can be caused by a variety of heart rhythm disorders.
A typical example of palpitations in adult patients is an irregular heart rhythm called Atrial Fibrillation, which is the most common heart rhythm disorder in the UK, affecting around 1.4 million people, or 2-3% of the adult population. It is important to treat and is associated with a higher risk of stroke.
Many clinical trials have repeatedly confirmed that in most people with atrial fibrillation, restoration of the normal rhythm can restore quality of life. Also the pivotal EAST-AFNET 4 trial (N Engl J Med. 2020 Oct 1;383(14):1305-1316. doi: 10.1056/NEJMoa2019422. ) confirmed that restoring normal rhythm as early as possible reduces the risk for cardiovascular death, stroke and hospitalisation for worsening heart failure and heart attacks.
The restoration of normal rhythm can be achieved with medication or a minimally invasive procedure to the heart called ablation.
Recent trials have demonstrated that ablation is superior to medication (Cryo-FIRST, EARLY AF, Stop AF First)( N Engl J Med. 2021 Jan 28;384(4):305-315. N Engl J Med. 2021 Jan 28;384(4):316-324Europace. 2021 Jul 18;23(7):1033-1041) in reducing the burden (number of episodes and duration of episodes) of AF in patients and also more successfully preventing progression of AF to being a persistent rhythm.
As a result of the superiority of ablation over medication in restoring normal rhythm, the 2024 guidelines of the European Society of Cardiology (European Heart Journal 2024 Sep 29;45(36):3314-3414. doi: 10.1093/eurheartj/ehae176.) have recommended that AF ablation can be considered as a first line treatment in patients with paroxysmal atrial fibrillation.
The SHAM-PVI trial (Pulmonary Vein Isolation vs Sham Intervention in Symptomatic Atrial Fibrillation: The SHAM-PVI Randomized Clinical Trial | Cardiology | JAMA | JAMA Network )investigated whether a procedure called pulmonary vein isolation (PVI), used to treat atrial fibrillation (an irregular heart rhythm), is effective compared to a placebo or "sham" procedure, where participants thought they were receiving treatment but actually did not.
The trial showed that patients who underwent the actual PVI procedure experienced a significant reduction in atrial fibrillation episodes compared to those who received the sham procedure. This suggests that PVI is effective in treating atrial fibrillation beyond just the psychological effects of believing one is receiving treatment. Essentially, the study confirmed that PVI works better than a placebo for this condition.
Coronary artery disease is very common in the UK. It is estimated that over 2 million people in the UK have significant disease. Heart artery disease can cause symptoms (angina) and may lead to a heart attack. Coronary artery disease is associated with risk factors such as hypertension (high blood pressure), high cholesterol,smoking and diabetes. Controlling and treating these risk factors is a major health priority.
The CLARIFY registry (European Heart Journal, Volume 45, Issue 27, 14 July 2024, Pages 2396–2406) studied a large group of people around the world who have stable coronary artery disease, which is when the blood vessels supplying the heart are narrowed but symptoms like chest pain are generally controlled. The goal was to understand how well these patients were doing over time and to identify factors that affect their health.
The results showed that, even though these patients were considered "stable," they still had a significant risk of serious events like heart attacks, strokes, or death. The study highlighted the importance of careful monitoring and continued treatment to manage their condition and reduce these risks. It also provided insights into which treatments and lifestyle changes could help improve outcomes for these patients.
