Trends in atrial fibrillation ablation: have we maximized the current paradigms?

Winkle, Roger; Mead, R.; Engel, Gregory; Kong, Melissa; Patrawala, Rob
July 2012
Journal of Interventional Cardiac Electrophysiology;Jul2012, Vol. 34 Issue 2, p115
Academic Journal
Purpose: The purpose of this study was to evaluate how atrial fibrillation (AF) ablation has evolved over time with regards to patient characteristics, procedural variables, complications, and outcomes. Methods: We evaluated trends over time from 2003 to 2010 in clinical characteristics, procedural variables, complications, and Kaplan-Meier AF-free rates after the initial and final AF ablation in 1,125 patients undergoing 1,504 ablations. Results: Evaluating trends from 2003 to 2010, we found that patients undergoing AF ablation became older ( P < 0.0001), had higher CHADS scores ( P < 0.0001), and more coronary artery disease ( P = 0.021), persistent AF ( P < 0.0001), hypertension ( P < 0.0001), and previous strokes/transient ischemic attacks ( P = 0.005). Procedure times decreased from 256 ± 49 to 122 ± 28 min ( P < 0.0005), fluoroscopy times decreased from 134 ± 29 to 56 ± 19 min ( P < 0.0005), and major ( P = 0.023), minor ( P = 0.023), and total complications ( P = 0.001) decreased over time. The learning curve to minimize complications was 6 years. For paroxysmal AF, initial ablation AF-free rates improved over time ( P = 0.015) but improvement plateaued in recent years. For persistent AF, initial ablation AF-free rates trended toward improvement over time ( P = 0.062) but also plateaued in recent years. For long-standing persistent AF ( P = 0.995), there was no outcome improvement after initial ablation over time. There was no trend for improved final outcomes (including repeat ablations) over time for paroxysmal, persistent, or long-standing AF ( P = 0.150 to P = 0.978). Conclusions: Despite decreased procedural and fluoroscopy times and reduced complication rates, post-ablation freedom from AF has not improved commensurately in recent years. A better understanding of AF initiation and maintenance may be required to devise personalized approaches to AF ablation and further improve outcomes.


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