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The Atrial Fibrillation Ablation Pilot Study: An European Survey on Methodology and Results of Catheter Ablation for Atrial Fibrillation: Conducted by the European Heart Rhythm Association
Study Questions:
What is the approach and outcome of patients undergoing catheter ablation of atrial fibrillation (AF) at various centers in Europe?
Methods:
The Atrial Fibrillation Ablation Pilot Study is a prospective, multicenter, observational registry of patients undergoing a first catheter ablation procedure at various European centers. Data were collected with respect to demographics, procedural approach, acute and long-term outcomes, and follow-up.
Results:
A total of 1,391 patients (67% with paroxysmal AF; CHADS2 <2 in 82%) underwent catheter ablation of AF. Oral anticoagulation was continued in 19%. Ablation was performed with an open irrigated catheter in 78%, cryoballoon in 13%, and duty-cycle multipolar catheters in 4%. Pulmonary veins (PVs) were targeted in nearly all patients. Complex electrograms were targeted in 18%, and linear lesions in approximately 20%. A complication occurred in 7.7% of patients, with cardiac perforation in 1.3%, thromboembolic events in 0.6%, and access site complications in 1.8%. There were three procedure-related deaths. After a follow-up of 1 year and repeat procedures in 18%, a successful outcome without antiarrhythmic medications (AADs) was noted in 44% of patients with paroxysmal, and 30% with persistent AF. Outcomes were better with AADs, which were employed in 43% of patients. Cardiac rhythm was assessed with a periodic electrocardiogram in the majority of patients. Although clinical practice varied among the various European regions, the outcomes did not seem to differ.
Conclusions:
This large registry offers a glimpse of the real-world practice of AF ablation at diverse European centers. The procedural success rate is lower than that reported in single-center studies.
Perspective:
Antral PV isolation eliminates paroxysmal AF in approximately 90% of patients without AADs, with a possibility of a repeat procedure, which is required in about one-third. Persistent AF is more challenging, but may be eliminated in approximately 75-80% of patients, again with repeat procedures. The reasons for the modest outcomes reported in this study are not clear. One reason may be the low frequency (18%) of repeat procedures. This study also highlights differences in practice between the participating European hospitals and university centers in the United States, such as periprocedural anticoagulation and long-term rhythm monitoring to assess efficacy.
Keywords: Carbamates, Pulmonary Veins, Europe, Catheter Ablation, United States, Atrial Flutter
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