Contemporary Atrial Fibrillation Ablation Registry Findings

Study Questions:

What are the outcomes of atrial fibrillation (AF) ablation in contemporary practice?

Methods:

The subjects of this study were 3,630 patients (median age 59 years, no structural heart disease in 32%, paroxysmal AF in 68%) who were enrolled in 2012-2015 into an AF registry at 104 European centers. Procedural data and 1-year follow-up information were captured from a web-based electronic database.

Results:

In 78% of patients, the ablation procedure was a first-time procedure. Radiofrequency energy was used in 80% of patients. All four pulmonary veins were isolated in approximately 95% of patients. Linear ablation was performed in the left atrium in 17% of patients and in the right atrium in 20% of patients. Complications included cardiac perforation in 1.5%, femoral vascular complications in 1.8%, stroke/embolism in 0.5%, and a fatal atria-esophageal fistula in 1/3,630 patients. All patients were taking an anticoagulant at discharge. At 12-month follow-up, the outcome was judged to have been successful in 74% of patients. However, almost 50% of the patients were still taking an antiarrhythmic drug. AF recurrences were less common in patients with paroxysmal (31%) than with persistent (40%) or long-standing persistent (44%) AF.

Conclusions:

In contemporary clinical practice, AF ablation is performed predominantly in patients with paroxysmal AF who often have lone AF, and the outcomes of ablation are satisfactory.

Perspective:

Only a small percentage of patients underwent adequate monitoring for asymptomatic recurrence of AF during follow-up, and a large percentage of patients remained on antiarrhythmic drug therapy. Therefore, the true success rate of AF ablation in this registry study almost certainly was lower than reported.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anti-Arrhythmia Agents, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Embolism, Esophageal Fistula, Pulmonary Veins, Secondary Prevention, Stroke


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