AFib Ablation Generally Successful But Not Exempt from Complication Risk

MedicalResearch.com Interview with:

Dr. Elena Arbelo MD PhD Department of Cardiology, Cardiovascular Institute Hospital Clínic de Barcelona. University of Barcelona Barcelona, Spain

Dr. Elena Arbelo

Dr. Elena Arbelo MD PhD
Department of Cardiology, Cardiovascular Institute
Hospital Clínic de Barcelona
University of Barcelona
Barcelona, Spain

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Almost 20 years after its first description, catheter ablation is a widely-used treatment strategy for patients with symptomatic atrial fibrillation (AF) (AFib) resistant to antiarrhythmic drugs (AAD).

If we look at the results of the ESC Pilot Atrial Fibrillation General Registry1, which included about 3000 consecutive in- and outpatients with AF presenting to cardiologists in nine participating countries in Europe, catheter ablation had previously attempted 7.6% overall, most often in those with paroxysmal AF (15.6%). A further 7.8% were prescribed an ablation as part of their management, which went up to a 19.3% in the case of paroxysmal AFib.

On the other hand, several randomised clinical trials (RCTs) have shown better results of AFib ablation compared to antiarrhythmic drugs (AADs)2-6. However, these studies had a rather small sample size of selected patients, and interventions were undertaken by experienced operators with clearly pre-specified protocols. With rising prevalence of AFib and increasingly available treatment options, it was of utmost importance to have an accurate picture of contemporary AFib ablation and its outcomes which will allow the identification of practice gaps and assist evidence-based guidelines for the management of these patients.

MedicalResearch.com: What are the main findings?

The principal findings of the ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry are:

  • Atrial Fibrillation ablation in everyday clinical practice is performed in symptomatic, relatively young and otherwise relatively healthy patients. Women are underrepresented in this group of patients undergoing catheter ablation for AFib; however, the underlying causes need to be further explored.
  • Most patients choose to undergo the intervention to relief symptoms (91%) and/or to improve their quality of life (66%).
  • In concordance to international guidelines recommendations, catheter ablation is mostly performed in symptomatic paroxysmal or persistent AFib refractory of intolerant to antiarrhythmic drugs and, as a first-line treatment, in 6.3% of patients with paroxysmal AFib.
  • Overall, success rate on or off antiarrhythmics is satisfactory (74%), and there was a significant improvement in the reported AFib-related symptoms following the ablation, with more than half the population asymptomatic at the 12-month visit. However, a significant portion of patients remain on antiarrhythmic drugs.
  • Patients and referring physicians should also be aware that complications may occur in 8% of patients periprocedurally and 11% during the 1-year follow-up.
  • This registry also reveals areas of suboptimal implementation of guideline recommendations, such as the existing wide variations in post-ablation patient monitoring and anticoagulation management.

MedicalResearch.com: What should readers take away from your report?

Response: The ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry shows that, in a real-world setting, catheter ablation is a valid alternative for the management of AFib with a satisfactory success rate on or off AADs. However, this procedure is not exempt of complications (some of them major), something that should be considered carefully by referring physicians and patients and reinforce the need for adherence to guidelines regarding indications and operator/centre experience.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry is a prospective observational study. We specifically avoided making any recommendation in terms of patient selection and use of diagnostic or therapeutic measures. Thus, the information we retrieved provides a true snapshot of current clinical practice across different regions of Europe, Middle East and North Africa. With 3630 patients from 104 centres in 27 countries, it is the largest international prospective registry on indications, patient characteristics, techniques and outcomes of catheter ablation of AFib to date. The amount of data gathered is enormous and we are now undertaking multiple ancillary analyses to understand several relevant issues in relation to AFib ablation: geographical differences, gender- or age-related factors, influence of other comorbidities, technical aspects of the procedure, detailed analysis of post-ablation monitoring and management, health-economic analyses, etc.

In the coming months, we expect to share with the public this detailed information which may help to improve current practices in AFib ablation.

No disclosures

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References:

  1. Lip GYH, Laroche C, Dan G-A, Santini M, Kalarus Z, Rasmussen LH, Oliveira MM, Mairesse G, Crijns HJGM, Simantirakis E, Atar D, Kirchhof P, Vardas P, Tavazzi L, Maggioni AP. A prospective survey in european society of cardiology member countries of atrial fibrillation management: Baseline results of eurobservational research programme atrial fibrillation (eorp-af) pilot general registry. Europace. 2014;16:308-319
  2. Tung R, Buch E, Shivkumar K. Catheter ablation of atrial fibrillation. Circulation. 2012;126:223-229
  3. Mont L, Bisbal F, Hernández-Madrid A, Pérez-Castellano N, Viñolas X, Arenal A, Arribas F, Fernández-Lozano I, Bodegas A, Cobos A, Matía R, Pérez-Villacastín J, Guerra JM, Ávila P, López-Gil M, Castro V, Arana JI, Brugada J, investigators oboS. Catheter ablation vs. Antiarrhythmic drug treatment of persistent atrial fibrillation: A multicentre, randomized, controlled trial (sara study). European Heart Journal. 2014;35:501-507
  4. Morillo CA, Verma A, Connolly SJ, Kuck KH, Nair GM, Champagne J, Sterns LD, Beresh H, Healey JS, Natale A, RAAFT-2 Investigators. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (raaft-2): A randomized trial. JAMA. 2014;311:692-700
  5. Verma A, Jiang C-y, Betts TR, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque J-P, Nardi S, Menardi E, Novak P, Sanders P. Approaches to catheter ablation for persistent atrial fibrillation. New England Journal of Medicine. 2015;372:1812-1822
  6. Kuck K-H, Brugada J, Fürnkranz A, Metzner A, Ouyang F, Chun KRJ, Elvan A, Arentz T, Bestehorn K, Pocock SJ, Albenque J-P, Tondo C. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. New England Journal of Medicine. 2016;374:2235-2245

Citation:

Arbelo E, 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. European Heart Journal, January 2017 DOI: 10.1093/eurheartj/ehw564

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