Vassilios P Vassilikos1, Efstathios D Pagourelias1, Cécile Laroche2, Carina Blomström-Lundqvist3, Josef Kautzner4, Aldo P Maggioni2,5, Luigi Tavazzi6, Nikolaos Dagres7, Josep Brugada8, Markus Stühlinger9, Elena Arbelo10,11,12. 1. Third Department of Cardiology, Hippokrateion General Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos str, 54642 Thessaloniki, Greece. 2. EURObservational Research Programme (EORP), European Society of Cardiology, Sophia-Antipolis, France. 3. Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden. 4. Department of Cardiology, Institute for Clinical and Experimental Medicine (ΙΚΕΜ), Prague, Czech Republic. 5. ANMCO Research Centre, Florence, Italy. 6. Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy. 7. Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany. 8. Hospital Clínic Pediatric Arrhythmia Unit, Cardiovascular Institute, Hospital Sant Joan de Déu University of Barcelona, Barcelona, Spain. 9. Clinic of Internal Medicine III/Cardiology, Medical University of Innsbruck, Innsbruck, Austria. 10. Department of Cardiology, Cardiovascular Institut, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain. 11. Instit d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 12. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Abstract
AIMS: The aim of the study was to investigate differences in clinical outcomes and complication rates among European atrial fibrillation (AF) ablation centres related to the volume of AF ablations performed. METHODS AND RESULTS: Data for this analysis were extracted from the ESC EHRA EORP European AF Ablation Long-Term Study Registry. Based on 33rd and 67th percentiles of number of AF ablations performed, the participating centres were classified into high volume (HV) (≥ 180 procedures/year), medium volume (MV) (<180 and ≥74/year), and low volume (LV) (<74/year). A total of 91 centres in 26 European countries enrolled in 3368 patients. There was a significantly higher reporting of cardiovascular complications and stroke incidence in LV centres compared with HV and MV (P = 0.039 and 0.008, respectively) and a lower success rate after AF ablation (55.3% in HV vs. 57.2% in LV vs. 67.4% in MV centres, P < 0.001), despite lower CHA2DS2-VASc score of patients, enrolled in LVs and less complex ablation techniques used. Adjustments of confounding factors (including type of AF ablation) led to elimination of these differences. CONCLUSION: Low-volume centres tended to present slightly higher cardiovascular complications' and stroke incidence and a lower unadjusted success rate after AF ablation, despite the fact that ablation procedures and patients were of lower risk compared with MV and HV centres. On the other hand, adjusted overall complication and recurrence rates were non-significantly different among different volume centres, a fact reflecting the heterogeneity of patient and procedural profiles, and a counterbalance between expertise and risk level among participating centres. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The aim of the study was to investigate differences in clinical outcomes and complication rates among European atrial fibrillation (AF) ablation centres related to the volume of AF ablations performed. METHODS AND RESULTS: Data for this analysis were extracted from the ESC EHRA EORP European AF Ablation Long-Term Study Registry. Based on 33rd and 67th percentiles of number of AF ablations performed, the participating centres were classified into high volume (HV) (≥ 180 procedures/year), medium volume (MV) (<180 and ≥74/year), and low volume (LV) (<74/year). A total of 91 centres in 26 European countries enrolled in 3368 patients. There was a significantly higher reporting of cardiovascular complications and stroke incidence in LV centres compared with HV and MV (P = 0.039 and 0.008, respectively) and a lower success rate after AF ablation (55.3% in HV vs. 57.2% in LV vs. 67.4% in MV centres, P < 0.001), despite lower CHA2DS2-VASc score of patients, enrolled in LVs and less complex ablation techniques used. Adjustments of confounding factors (including type of AF ablation) led to elimination of these differences. CONCLUSION: Low-volume centres tended to present slightly higher cardiovascular complications' and stroke incidence and a lower unadjusted success rate after AF ablation, despite the fact that ablation procedures and patients were of lower risk compared with MV and HV centres. On the other hand, adjusted overall complication and recurrence rates were non-significantly different among different volume centres, a fact reflecting the heterogeneity of patient and procedural profiles, and a counterbalance between expertise and risk level among participating centres. Published on behalf of the European Society of Cardiology. All rights reserved.