Zak Loring1,2, DaJuanicia N Holmes1, Roland A Matsouaka1,3, Anne B Curtis4, John D Day5, Nihar Desai6, Kenneth A Ellenbogen7, Gregory K Feld8, Gregg C Fonarow9, David S Frankel10, Jodie L Hurwitz11, Bradley P Knight12, Jose A Joglar13, Andrea M Russo14, Mandeep S Sidhu15, Mintu P Turakhia16,17, William R Lewis18, Jonathan P Piccini1,2. 1. Duke Clinical Research Institute (Z.L., D.N.H., R.A.M., J.P.P.), Duke University Medical Center. 2. Division of Cardiology (Z.L., J.P.P.), Duke University Medical Center. 3. Department of Biostatistics & Bioinformatics, Duke University, Durham, NC (R.A.M.). 4. Department of Medicine, University at Buffalo, NY (A.B.C.). 5. Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (J.D.D.). 6. Cardiovascular Medicine Section, Yale University, New Haven, CT (N.D.). 7. Division of Cardiology, Virginia Commonwealth University, Richmond (K.A.E.). 8. Department of Medicine, University of California San Diego (G.K.F.). 9. Department of Medicine, University of California Los Angeles (G.C.F.). 10. Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.S.F.). 11. North Texas Heart Center, Dallas (J.L.H.). 12. Feinberg School of Medicine, Northwestern University, Chicago, IL (B.P.K.). 13. Department of Cardiology, University of Texas, Southwestern Medical Center, Dallas (J.A.J.). 14. Cooper Medical School of Rowan University, Camden, NJ (A.M.R.). 15. Division of Cardiology, Albany Medical Center, NY (M.S.S.). 16. VA Palo Alto Health Care System, Palo Alto, CA (M.P.T.). 17. Center for Digital Health, Stanford University, Stanford, CA (M.P.T.). 18. MetroHealth System Campus, Case Western Reserve University, Cleveland, OH (W.R.L.).
Abstract
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.
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.
Authors: Karim Abdur Rehman; Oussama M Wazni; Amr F Barakat; Walid I Saliba; Shailee Shah; Khaldoun G Tarakji; John Rickard; Mohamed Bassiouny; Bryan Baranowski; Patrick J Tchou; Mandeep Bhargava; Thomas J Dresing; Thomas D Callahan; Daniel J Cantillon; Mina Chung; Mohamed Kanj; Samuel Irefin; Bruce Lindsay; Ayman A Hussein Journal: JACC Clin Electrophysiol Date: 2019-01-30
Authors: Jonathan P Piccini; Moritz F Sinner; Melissa A Greiner; Bradley G Hammill; João D Fontes; James P Daubert; Patrick T Ellinor; Adrian F Hernandez; Allan J Walkey; Susan R Heckbert; Emelia J Benjamin; Lesley H Curtis Journal: Circulation Date: 2012-09-26 Impact factor: 29.690
Authors: Luigi Di Biase; J David Burkhardt; Pasquale Santangeli; Prasant Mohanty; Javier E Sanchez; Rodney Horton; G Joseph Gallinghouse; Sakis Themistoclakis; Antonio Rossillo; Dhanunjaya Lakkireddy; Madhu Reddy; Steven Hao; Richard Hongo; Salwa Beheiry; Jason Zagrodzky; Bai Rong; Sanghamitra Mohanty; Claude S Elayi; Giovanni Forleo; Gemma Pelargonio; Maria Lucia Narducci; Antonio Dello Russo; Michela Casella; Gaetano Fassini; Claudio Tondo; Robert A Schweikert; Andrea Natale Journal: Circulation Date: 2014-04-17 Impact factor: 29.690
Authors: Yvonne L Douglas; Monique R M Jongbloed; Adriana C Gittenberger-de Groot; Dorothea Evers; Robert A E Dion; Pieter Voigt; Margot M Bartelings; Martin J Schalij; Tjark Ebels; Marco C DeRuiter Journal: Am J Cardiol Date: 2006-01-10 Impact factor: 2.778
Authors: Karl-Heinz Kuck; Josep Brugada; Alexander Fürnkranz; Andreas Metzner; Feifan Ouyang; K R Julian Chun; Arif Elvan; Thomas Arentz; Kurt Bestehorn; Stuart J Pocock; Jean-Paul Albenque; Claudio Tondo Journal: N Engl J Med Date: 2016-04-04 Impact factor: 91.245
Authors: Fredrik Holmqvist; Milos Kesek; Anders Englund; Carina Blomström-Lundqvist; Lars O Karlsson; Göran Kennebäck; Dritan Poçi; Romeo Samo-Ayou; Runa Sigurjónsdóttir; Michael Ringborn; Csaba Herczku; Jonas Carlson; Espen Fengsrud; Fariborz Tabrizi; Niklas Höglund; Stefan Lönnerholm; Ole Kongstad; Anders Jönsson; Per Insulander Journal: Eur Heart J Date: 2019-03-07 Impact factor: 29.983
Authors: Jamario Skeete; Parikshit S Sharma; David Kenigsberg; Grzegorz Pietrasik; Ahmed F Osman; Venkatesh Ravi; Jeanne M Du-Fay-de-Lavallaz; Zoe Post; Jeremiah Wasserlauf; Timothy R Larsen; Kousik Krishnan; Richard Trohman; Henry D Huang Journal: J Arrhythm Date: 2022-05-06
Authors: Emmanouil Charitakis; Silvia Metelli; Lars O Karlsson; Antonios P Antoniadis; Konstantinos D Rizas; Ioan Liuba; Henrik Almroth; Anders Hassel Jönsson; Jonas Schwieler; Dimitrios Tsartsalis; Skevos Sideris; Elena Dragioti; Nikolaos Fragakis; Anna Chaimani Journal: BMC Med Date: 2022-05-31 Impact factor: 11.150
Authors: Emmanouil Charitakis; Silvia Metelli; Lars O Karlsson; Antonios P Antoniadis; Ioan Liuba; Henrik Almroth; Anders Hassel Jönsson; Jonas Schwieler; Skevos Sideris; Dimitrios Tsartsalis; Elena Dragioti; Nikolaos Fragakis; Anna Chaimani Journal: Diagnostics (Basel) Date: 2022-02-09
Authors: Allyson L Varley; Omar Kreidieh; Brigham E Godfrey; Carolyn Whitmire; Susan Thorington; Benjamin D'Souza; Steven Kang; Shrinivas Hebsur; Bipin K Ravindran; Edwin Zishiri; Brett Gidney; Matthew B Sellers; David Singh; Tariq Salam; Mark Metzl; Alex Ro; Jose Nazari; Westby G Fisher; Alexandru Costea; Anthony Magnano; Saumil Oza; Gustavo Morales; Anil Rajendra; Joshua Silverstein; Paul C Zei; Jose Osorio Journal: J Interv Card Electrophysiol Date: 2021-07-02 Impact factor: 1.900