Procedure using Boston Scientific device tops medication for heart rhythm problem

(This is an excerpt of the Health Rounds newsletter, where we present latest medical studies on Tuesdays and Thursdays.)

By Nancy Lapid

April 29 (Reuters) - We also report below on early data that poses a possible solution to a devastating pregnancy complication, and a potential breakthrough treatment for liver transplant patients. 

HEART PROCEDURE SUPERIOR TO DRUGS FOR COMMON ARRHYTHMIA

A minimally invasive procedure that “rewires” the heart may be a better option than medication for patients with unremitting cases of the heart rhythm disorder atrial fibrillation, or AFib, according to results of a new clinical trial. 

Atrial fibrillation raises the risk of stroke by five times and also increases risk of heart failure and early death.

Although minimally invasive procedures are increasingly being employed in patients with paroxysmal, or intermittent, AFib, guidelines still recommend patients with persistent AFib be treated with medications first. 

In the study, 310 patients with previously untreated persistent AFib received either traditional medications or underwent pulsed-field catheter ablation with Boston Scientific's Farapulse system.

Under that process, physicians guide thin electrical leads through blood vessels into the heart to deliver short bursts of electrical energy to precisely target and eliminate the heart tissue responsible for triggering and sustaining the abnormal electrical signals.

“You can think of it as resetting the heart's electrical system,” study leader Dr. Jason Andrade of the University of British Columbia said in a statement. 

One year later, 56% of patients who underwent ablation were free of abnormal heart rhythms, compared with 30% of those who had started on antiarrhythmic drug therapy, researchers reported at the Heart Rhythm 2026 meeting and in The New England Journal of Medicine.    

The overall risk of serious adverse events was similar in the two groups, they found.

“Traditionally, we’ve taken a stepwise approach, starting with medications and moving to procedures later,” Andrade said. “What this trial shows is that, even in patients with more advanced AFib, earlier intervention with ablation can provide substantial benefits and better control of the disease.”

BLOOD FILTERING MAY CONTROL DANGEROUS PREGNANCY COMPLICATION

A blood-filtering treatment can safely prolong pregnancy in women who might otherwise need to be induced early because of dangerously high blood pressure, a pilot study suggests.

The treatment could help to slow the progression of preeclampsia during pregnancy and reduce the risk of preterm delivery, researchers said, while noting that larger studies are needed to confirm their findings. 

There is currently no treatment for preeclampsia other than delivering the baby. 

A placental protein called sFlt-1 is thought to play an important role in development of preeclampsia, with levels increasing as the mother's high blood pressure continues to worsen, the researchers explained in Nature Medicine.

They used a blood-filtering technique called apheresis to remove sFlt-1 from the blood, first in pregnant baboons and later in 16 women with very early preeclampsia.  

Pregnancy continued for a median of 10 days in the women who were treated with apheresis, the researchers said, about twice as long as would have been expected without the treatments.

Side effects in mothers were mild and there were no major complications in the babies, according to the report.

“This first-in-human study shows that treating women with very preterm preeclampsia with (apheresis) appears to be safe and tolerable to mother, fetus" and the newborn baby, the report found. 

“While controlled trials are needed to determine whether this strategy safely and effectively extends pregnancy in very preterm preeclampsia, our study provides the necessary groundwork to address one of the most devastating complications of pregnancy.”

ADVANCE IMMUNE PREP MAY PREVENT LIVER TRANSPLANT REJECTION

A new immune system priming technique may help some transplant recipients avoid the need to take strong immunosuppressive drugs for the rest of their lives, a first-in-human trial suggests.

“Long-term use of immunosuppressive drugs can harm the kidneys, causes metabolic complications, and makes patients more susceptible to infections and certain types of cancer, as well as diabetes,” study leader Angus Thomson of the University of Pittsburgh said in a statement. 

The 13 patients in the study received liver portions donated by live donors in scheduled procedures. Because the liver can regenerate, a healthy person can donate a portion of their liver to someone whose liver is failing.

Each patient received an infusion of immune cells from the donor a week before transplantation, with the expectation that the cells would “instruct” the recipient’s immune system to recognize the donor liver as friendly and not reject it. 

A year later, the recipients were tested to judge the likelihood that immunosuppression could be reduced or withdrawn without risking organ rejection.

Eight patients were eligible and four achieved complete withdrawal of immunosuppression, with three remaining off the immunosuppressants for more than three years, the researchers reported in Nature Communications. 

Sparing patients from serious side effects has been a decades-long goal of transplant teams, Thomson said. 

“While we haven’t hit a home run yet, we’ve definitely gotten on base by reliably and safely removing immunosuppression early after transplantation from a significant percentage of patients, which is a huge breakthrough,” study coauthor Dr. Abhinav Humar, also from the University of Pittsburgh, said in a statement.

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(Reporting by Nancy Lapid; Editing by Bill Berkrot)