Methods, efficacy and safety
Introduction. After its introduction in 1994, CA of AF has shown curative potential and according to the literature, one every four patients with AF could represent a candidate for this therapy in clinical practice.
Aim of the study. The purpose of this study was to conduct a worldwide survey investigating the methods, efficacy and safety of catheter ablation (CA) of atrial fibrillation (AF).
Methods and Results. A detailed questionnaire was sent to 777 centers worldwide. The centers were selected from official sources of national or international societies. The questionnaire was conceived to examine the following post-ablation outcome parameters: freedom from recurrent AF in the absence of antiarrhythmic drugs; freedom from recurrent AF in the presence of formerly ineffective antiarrhythmic drugs; overall freedom from recurrent AF (i.e., both in the absence and the presence of orally administered antiarrhythmic drugs); and, development of major complications.
Data relevant to the study purpose were collected from 181 centers (23.3%), of which 100 had ongoing programs on CA of AF between 1995 and 2002. The number of patients undergoing this procedure increased from 18 in 1995 to 5,050 in 2002. The median number of procedures per center was 37.5 (range, 1 - 600). Paroxysmal, persistent and permanent AF were the indicated arrhythmias in 100.0%, 53.0% and 20.0% of responding centers, respectively. The most commonly used techniques were right atrial compartmentalization between 1995 and 1997, ablation of the triggering focus in 1998 and 1999 and electrical disconnection of multiple pulmonary veins between 2000 and 2002. Out of 8,745 patients completing the CA protocol in 90 centers, of whom 2,389 (27.3%) required more than one procedure, 4,550 (52.0%) became asymptomatic without drugs and other 2,094 (23.9%) became asymptomatic in the presence of formerly ineffective antiarrhythmic drugs over 11. 6 ± 7.7 months follow up.
A major complication occurred in 524 patients (6.0%) (see table). The most significant complications included 4 patient early deaths (extra-pericardial PV perforation in 1, massive cerebral thrombo-embolism in 2 and unknown in 1), 20 strokes, 47 transient ischemic attacks and 107 episodes of tamponade. Altogether, 117 PVs sustained significant (>50%) stenosis , which resulted in the need for a corrective intervention in 53 patients (0.7% of 7,154 patients undergoing ablation in the left atrium). Atypical atrial flutter of new onset (iatrogenic) was reported in 340 patients (3.9%), and was significantly (p < 0.001) more frequently observed in centers using exclusively 3D-guided compartmentalization strategies (8.4%) than in centers performing exclusively ablation of the triggering substrate or PV electrical disconnection (0.8%)
Conclusions. The findings of this survey provide a picture of the variable and evolving methods, efficacy and safety of CA of AF as practiced in a large number of laboratories worldwide and may serve as a guide to clinicians considering therapeutic options in patients suffering from this arrhythmia.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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