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
What is the approach and outcome of patients undergoing catheter ablation of atrial fibrillation (AF) at various centers in Europe?
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.
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.
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.
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
< Back to Listings