Sam Riahi1, Elena Arbelo2, Josep Brugada2, Aldo Pietro Maggioni3, Luigi Tavazzi4, Panos Vardas5, Cécile Laroche6, Michalis Efremidis7, Olivier Xhaet8, Aleksandra Woźniak9, Isabelle C Van Gelder10, Soren Hjortshoj11. 1. AF-Study Group, Department of Cardiology, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark sar@rn.dk. 2. Hospital Clinic, University of Barcelona, Barcelona, Spain. 3. EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France ANMCO Research Center, Florence, Italy. 4. GVM Care and Research, E.S. Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy. 5. Department of Cardiology, Heraklion University Hospital, Crete, Greece. 6. EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France. 7. Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece. 8. Department of Rythmology, CHU Dinant-Godinne UCL, Yvoir, Belgium. 9. Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland. 10. Department of Cardiology, University of Groningen, Groningen, The Netherlands. 11. AF-Study Group, Department of Cardiology, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark.
Abstract
AIMS: Ablation is an effective treatment of symptomatic and drug refractory atrial fibrillation (AF). Using data from the European AF Ablation Pilot Registry comprising 1410 patients from 10 European countries, we prospectively investigated regional differences in AF ablation regarding patient selection, ablation strategy, and outcome. METHODS AND RESULTS: Countries were divided into three regions: South (Greece, Italy, Spain), East (Czech Republic, Poland), and West/North (Belgium, Denmark, France, Germany, and the Netherlands). One-year success was defined as patient survival free from atrial arrhythmia, with or without antiarrhythmic drugs (AAD). In all regions, patients were symptomatic and treated extensively with beta-blockers and AAD pre-ablation. Patients in East had more co-morbidity, increased thromboembolic risk, were more likely to have paroxysmal AF, and they underwent more left atrial linear ablations. Adverse events remained within expected levels, albeit with a significantly higher reporting of adverse cardiovascular events in the West/North (4.7 vs. 1.4 and 1.5% in South and East, P = 0.0032). There was no significant difference in peripheral/vascular, neurological, pulmonary, gastrointestinal, or general adverse events. The 1-year success rate after ablation differed non-statistically between regions ranging from 69.1 to 74.7%. A second ablation was performed in 23.2% in West/North compared with 10.5 and 16.5% in South and East. The proportion of patients still on AADs was highest in the South region (51.6 vs. 42.3 and 38.8% in East and West/North). CONCLUSION: This study with all-comer patients shows that patient selection for ablation follows current guidelines but reveals significant differences regarding co-morbidity, medication, and ablation strategy. Despite this, 1-year outcomes are without significant differences and in line with previously published clinical trials. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Ablation is an effective treatment of symptomatic and drug refractory atrial fibrillation (AF). Using data from the European AF Ablation Pilot Registry comprising 1410 patients from 10 European countries, we prospectively investigated regional differences in AF ablation regarding patient selection, ablation strategy, and outcome. METHODS AND RESULTS: Countries were divided into three regions: South (Greece, Italy, Spain), East (Czech Republic, Poland), and West/North (Belgium, Denmark, France, Germany, and the Netherlands). One-year success was defined as patient survival free from atrial arrhythmia, with or without antiarrhythmic drugs (AAD). In all regions, patients were symptomatic and treated extensively with beta-blockers and AAD pre-ablation. Patients in East had more co-morbidity, increased thromboembolic risk, were more likely to have paroxysmal AF, and they underwent more left atrial linear ablations. Adverse events remained within expected levels, albeit with a significantly higher reporting of adverse cardiovascular events in the West/North (4.7 vs. 1.4 and 1.5% in South and East, P = 0.0032). There was no significant difference in peripheral/vascular, neurological, pulmonary, gastrointestinal, or general adverse events. The 1-year success rate after ablation differed non-statistically between regions ranging from 69.1 to 74.7%. A second ablation was performed in 23.2% in West/North compared with 10.5 and 16.5% in South and East. The proportion of patients still on AADs was highest in the South region (51.6 vs. 42.3 and 38.8% in East and West/North). CONCLUSION: This study with all-comer patients shows that patient selection for ablation follows current guidelines but reveals significant differences regarding co-morbidity, medication, and ablation strategy. Despite this, 1-year outcomes are without significant differences and in line with previously published clinical trials. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Leon Dinshaw; Paula Münkler; Benjamin Schäffer; Niklas Klatt; Christiane Jungen; Jannis Dickow; Annika Tamenang; Ruben Schleberger; Simon Pecha; Hans Pinnschmidt; Monica Patten; Hermann Reichenspurner; Stephan Willems; Christian Meyer Journal: J Am Heart Assoc Date: 2021-01-17 Impact factor: 5.501
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