Patterns of catheter ablation practice in the United States: results of the 1992 NASPE survey. North American Society of Pacing and Electrophysiology.

Any conclusion drawn must be made within the context of all the limitations inherent in a voluntary retrospective survey. The primary purpose of this survey is to provide a general picture of current catheter ablative procedure practiced in the United States. This is felt to be of value in calling attention to significant trends and to highlight those areas in which improvement is needed. Improvement may be required in terms of operator experience as well as improved catheters and energy delivery systems. The striking finding was a plateau in total number of procedures from 1991 to 1992. The decline in numbers of patients undergoing ablation of accessory pathways was more than compensated for by impressive growth in numbers of patients undergoing ablative procedures for atrioventricular nodal reentry, atrial tachycardia/atrial flutter, and ventricular tachycardia. The ablative data suggest that continued improvements are needed for successful ablation of patients with right-sided accessory pathways. The anatomy of the tricuspid annulus makes for difficulty in achieving catheter stability and this report highlights the need for better catheters designed for right-sided pathway ablation. Equally concerning is the incidence of procedure related deaths (0.2%) and significant complications (2.1%) for patients with accessory pathways. This is no doubt related to the need for left heart catheterization in the majority of patients. The latter involves either retrograde aortic passage of the relatively stiff ablation catheters or use of transseptal puncture. In addition, we found that 35 of the 164 centers performed less than 20 procedures a year and low volume centers had a higher incidence of complications.(ABSTRACT TRUNCATED AT 250 WORDS)