Contemporary Atrial Fibrillation Ablation Registry Findings
What are the outcomes of atrial fibrillation (AF) ablation in contemporary practice?
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.
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.
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.
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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