TITLE

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

AUTHOR(S)
Winkle, Roger; Mead, R.; Engel, Gregory; Kong, Melissa; Patrawala, Rob
PUB. DATE
July 2012
SOURCE
Journal of Interventional Cardiac Electrophysiology;Jul2012, Vol. 34 Issue 2, p115
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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.
ACCESSION #
77736939

 

Related Articles

  • Intra-atrial endothelial lesion resulting from transseptal puncture for catheter ablation of atrial fibrillation. Genz, Conrad; Esperer, Hans D.; Schmeisser, Alexander; Braun-Dullaeus, Ruediger C.; Said, Samir M. // Heart International;Jul2012, Vol. 7 Issue 2, p40 

    Thromboembolic events are known complications of left atrial ablation therapy. We describe a complication which may also lead to systemic thromboembolism that has not been reported so far: the formation of a moving structure attached to the fossa ovalis after an attempted transseptal puncture in...

  • Ablation for atrial fibrillation: what are acceptable levels of experience, efficacy, and complications? Anderson, Kelley // Journal of Interventional Cardiac Electrophysiology;Jul2012, Vol. 34 Issue 2, p125 

    The author discusses the procedure experience, efficacy and complications associated with catheter ablation for atrial fibrillation (AF). He cites the results of a survey on major procedural complications of radiofrequency catheter ablation for AF during the 2003-06 period. According to the...

  • Magnetically guided irrigated gold-tip catheter ablation of persistent atrial fibrillation-techniques, procedural parameters and outcome. Muntean, Bogdan; Gutleben, Klaus-Jürgen; Heintze, Johannes; Vogt, Jürgen; Horstkotte, Dieter; Nölker, Georg // Journal of Interventional Cardiac Electrophysiology;Nov2012, Vol. 35 Issue 2, p163 

    Purpose: Magnetically guided irrigated ablation has been introduced for atrial fibrillation (AF) ablation. However, data on ablation of persistent AF is scarce, and first-generation platinum-iridium catheters were burdened by char formation at the catheter tip. Furthermore, energy transmission...

  • Comparing Safety and Efficacy of Irrigated Radiofrequency Catheter Ablation Versus Combined Cryoballoon and Catheter Ablation for Persistent Atrial Fibrillation. Kosmidou, Ioanna; Sumayin, Kyari; Deering, Thomas; Wickliffe, Andrew; Kanitpudi, Sricharan; Prater, Stephen; Dan, Dan // JAFIB: Journal of Atrial Fibrillation;Oct/Nov2013, Vol. 6 Issue 3, p13 

    Background :Catheter and cryoballoon ablation are established treatments for atrial fibrillation. Frequently, substrate modification of the left atrium is performed in patients with persistent AF or evidence of left atrial adverse remodeling. We compared one year outcomes of AF ablation with...

  • Reasons to be cheerful about ablation. Ward, David E. // BMJ: British Medical Journal;10/5/2013, Vol. 347 Issue 7927, p22 

    A letter to the editor is presented in response to the article "Caution Over Use of Catheter Ablation for Atrial Fibrillation," by H. Van Brabandt et al. in the 2013 issue.

  • A Better Technique for Ablation of Persistent Atrial Fibrillation? Dimarco, John P. // Clinical Cardiology Alert;Sep2012, Vol. 31 Issue 9, p71 

    The author discusses a study by S.M. Narayan and colleagues on the clinical utility of impulse and rotor mapping to guide atrial fibrillation (AF) ablation, which concluded that the technique was found to be quite effective in the case of patients with AF. A commentary is also presented on the...

  • Caution over use of catheter ablation for atrial fibrillation. Van Brabandt, Hans; Neyt, Mattias; Devos, Carl // BMJ: British Medical Journal;9/14/2013, Vol. 347 Issue 7924, p15 

    The authors discuss the usage of catheter ablation for atrial fibrillation. They explain that catheter ablation was developed to cure atrial fibrillation, eradicate symptoms, and prevent stroke. They also note how trials have demonstrated that a small subgroup of drug resistant patients with...

  • Studies show success rates on the rise for catheter ablation procedures. Raible, Eric // Cardiology Today;Mar2009, Vol. 12 Issue 3, p15 

    The article discusses the results of a study on success rates of catheter ablation for atrial fibrillation (AF) presented by Riccardo Cappato, an electrophysiologist with the Instituto Poli-clinico San Donator in Milan, Italy, at the Second Worldwide Survey on the Efficacy and Safety of Catheter...

  • ESC Congress 2012: Gold standards of success defined for AF ablation.  // Biomedical Market Newsletter;8/28/2012, Vol. 21, p1 

    The article informs that an international consensus statement has revealed the catheter and surgical ablation of atrial fibrillation have been defined gold standards of success.

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics