Procedural Patterns and Safety of Atrial Fibrillation Ablation

Supplemental Digital Content is available in the text. Background: Catheter ablation is an increasingly used treatment for symptomatic atrial fibrillation (AF). However, there are limited prospective, nationwide data on patient selection and procedural characteristics. This study describes patient characteristics, techniques, treatment patterns, and safety outcomes of patients undergoing AF ablation. Methods: A total of 3139 patients undergoing AF ablation between 2016 and 2018 in the Get With The Guidelines-Atrial Fibrillation registry from 24 US centers were included. Patient demographics, medical history, procedural details, and complications were abstracted. Differences between paroxysmal and patients with persistent AF were compared using Pearson χ2 and Wilcoxon rank-sum tests. Results: Patients undergoing AF ablation were predominantly male (63.9%) and White (93.2%) with a median age of 65. Hypertension was the most common comorbidity (67.6%), and patients with persistent AF had more comorbidities than patients with paroxysmal AF. Drug refractory, paroxysmal AF was the most common ablation indication (class I, 53.6%) followed by drug refractory, persistent AF (class I, 41.8%). Radiofrequency ablation with contact force sensing was the most common ablation modality (70.5%); 23.7% of patients underwent cryoballoon ablation. Pulmonary vein isolation was performed in 94.6% of de novo ablations; the most common adjunctive lesions included left atrial roof or posterior/inferior lines, and cavotricuspid isthmus ablation. Complications were uncommon (5.1%) and were life-threatening in 0.7% of cases. Conclusions: More than 98% of AF ablations among participating sites are performed for class I or class IIA indications. Contact force-guided radiofrequency ablation is the dominant technique and pulmonary vein isolation the principal lesion set. In-hospital complications are uncommon and rarely life-threatening.

[1]  Hugh Calkins,et al.  Correction to: 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. , 2019, Circulation.

[2]  J. Brachmann,et al.  Outcomes of cryoballoon or radiofrequency ablation in symptomatic paroxysmal or persistent atrial fibrillation , 2019, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[3]  G. Hindricks,et al.  Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial , 2019, JAMA.

[4]  Pamela J. McCabe,et al.  Adherence to Guideline-Directed Stroke Prevention Therapy for Atrial Fibrillation Is Achievable: First Results From Get With The Guidelines–Atrial Fibrillation (GWTG-AFIB) , 2019, Circulation.

[5]  C. Blomström-Lundqvist,et al.  A decade of catheter ablation of cardiac arrhythmias in Sweden: ablation practices and outcomes , 2018, European heart journal.

[6]  M. Chung,et al.  Life-Threatening Complications of Atrial Fibrillation Ablation: 16-Year Experience in a Large Prospective Tertiary Care Cohort. , 2019, JACC. Clinical electrophysiology.

[7]  Paul C. Zei,et al.  Temporal trends in safety and complication rates of catheter ablation for atrial fibrillation , 2018, Journal of cardiovascular electrophysiology.

[8]  K. Zeppenfeld,et al.  The Impact of Advances in Atrial Fibrillation Ablation Devices on the Incidence and Prevention of Complications. , 2018, Arrhythmia & electrophysiology review.

[9]  J. Viles‐Gonzalez,et al.  Temporal trends of in‐hospital complications associated with catheter ablation of atrial fibrillation in the United States: An update from Nationwide Inpatient Sample database (2011–2014) , 2018, Journal of cardiovascular electrophysiology.

[10]  L. Jordaens,et al.  Catheter Ablation for Atrial Fibrillation with Heart Failure , 2018, The New England journal of medicine.

[11]  Dhanunjaya R. Lakkireddy,et al.  Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation , 2017, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[12]  M. Chung,et al.  2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation , 2017, Heart rhythm.

[13]  F. Marchlinski,et al.  Techniques for the provocation, localization, and ablation of non-pulmonary vein triggers for atrial fibrillation. , 2017, Heart rhythm.

[14]  M. Chung,et al.  2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation , 2017, Heart rhythm.

[15]  G. Hindricks,et al.  Contemporary management of patients undergoing atrial fibrillation ablation: in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry , 2017, European heart journal.

[16]  K. Chun,et al.  Complications in Catheter Ablation of Atrial Fibrillation in 3,000 Consecutive Procedures: Balloon Versus Radiofrequency Current Ablation. , 2017, JACC. Clinical electrophysiology.

[17]  H. Krumholz,et al.  National Trends in Atrial Fibrillation Hospitalization, Readmission, and Mortality for Medicare Beneficiaries, 1999–2013 , 2017, Circulation.

[18]  Paul J. Wang,et al.  Safety and Clinical Outcomes of Catheter Ablation of Atrial Fibrillation in Patients With Chronic Kidney Disease , 2017, Journal of cardiovascular electrophysiology.

[19]  P. Kirchhof,et al.  2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. , 2016, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[20]  P. Kirchhof,et al.  2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. , 2016, European heart journal.

[21]  S. Pocock,et al.  Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. , 2016, The New England journal of medicine.

[22]  P. Noseworthy,et al.  Patterns of Anticoagulation Use and Cardioembolic Risk After Catheter Ablation for Atrial Fibrillation , 2015, Journal of the American Heart Association.

[23]  Prashanthan Sanders,et al.  Approaches to catheter ablation for persistent atrial fibrillation. , 2015, The New England journal of medicine.

[24]  S. Shin,et al.  Does isolation of the left atrial posterior wall improve clinical outcomes after radiofrequency catheter ablation for persistent atrial fibrillation?: A prospective randomized clinical trial. , 2015, International journal of cardiology.

[25]  Biykem Bozkurt,et al.  2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2014, Circulation.

[26]  M. Ezekowitz,et al.  2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. , 2014, Circulation.

[27]  M. Turakhia,et al.  Get With The Guidelines AFIB: Novel Quality Improvement Registry for Hospitalized Patients With Atrial Fibrillation , 2014, Circulation. Cardiovascular quality and outcomes.

[28]  N. Choudhry,et al.  The Current State of Ethnic and Racial Disparities in Cardiovascular Care: Lessons from the Past and Opportunities for the Future , 2014, Current Cardiology Reports.

[29]  Dhanunjaya R. Lakkireddy,et al.  Periprocedural Stroke and Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation With Different Anticoagulation Management: Results From the Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) Rand , 2014, Circulation.

[30]  E. Benjamin,et al.  Outcomes of Medicare Beneficiaries Undergoing Catheter Ablation for Atrial Fibrillation , 2012, Circulation.

[31]  Kevin L. Thomas,et al.  Trends in Use of Implantable Cardioverter-Defibrillator Therapy Among Patients Hospitalized for Heart Failure: Have the Previously Observed Sex and Racial Disparities Changed Over Time? , 2012, Circulation.

[32]  Eric E. Smith,et al.  Data quality in the American Heart Association Get With The Guidelines-Stroke (GWTG-Stroke): results from a national data validation audit. , 2012, American heart journal.

[33]  Gregory Y H Lip,et al.  A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. , 2010, Chest.

[34]  Atul Verma,et al.  Substrate and Trigger Ablation for Reduction of Atrial Fibrillation (STAR AF): a randomized, multicentre, international trial† , 2010, European heart journal.

[35]  Gregory Y H Lip,et al.  Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. , 2010, Chest.

[36]  B. Knight,et al.  Approaches to catheter ablation of persistent atrial fibrillation. , 2009, Heart rhythm.

[37]  M. Schalij,et al.  Histology of vascular myocardial wall of left atrial body after pulmonary venous incorporation. , 2006, The American journal of cardiology.

[38]  Elia Biganzoli,et al.  Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation , 2005, Circulation. Arrhythmia and electrophysiology.