Contemporary management of patients undergoing atrial fibrillation ablation: in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry

• Published in: European heart journal 2017-05, Vol.38 (17), p.1303-1316
• Main Authors: Arbelo, Elena, Brugada, Josep, Blomström-Lundqvist, Carina, Laroche, Cécile, Kautzner, Josef, Pokushalov, Evgeny, Raatikainen, Pekka, Efremidis, Michael, Hindricks, Gerhard, Barrera, Alberto, Maggioni, Aldo, Tavazzi, Luigi, Dagres, Nikolaos
• Format: Article
• Language: English
• Subjects: Ablation; Anticoagulants - therapeutic use; Atrial fibrillation; Atrial Fibrillation - surgery; Catheter Ablation - adverse effects; Catheter Ablation - methods; Catheter Ablation - statistics & numerical data; Complications; Europe; Female; Follow-Up Studies; Hospitalization - statistics & numerical data; Humans; Length of Stay - statistics & numerical data; Male; Management; Middle Aged; Outcomes; Postoperative Complications - etiology; Preoperative Care; Prospective registry; Prospective Studies; Registries
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehw564

The ESC-EHRA Atrial Fibrillation Ablation Long-Term registry is a prospective, multinational study that aims at providing an accurate picture of contemporary real-world ablation for atrial fibrillation (AFib) and its outcome. A total of 104 centres in 27 European countries participated and were asked to enrol 20-50 consecutive patients scheduled for first and re-do AFib ablation. Pre-procedural, procedural and 1-year follow-up data were captured on a web-based electronic case record form. Overall, 3630 patients were included, of which 3593 underwent an AFib ablation (98.9%). Median age was 59 years and 32.4% patients had lone atrial fibrillation. Pulmonary vein isolation was attempted in 98.8% of patients and achieved in 95-97%. AFib-related symptoms were present in 97%. In-hospital complications occurred in 7.8% and one patient died due to an atrioesophageal fistula. One-year follow-up was performed in 3180 (88.6%) at a median of 12.4 months (11.9-13.4) after ablation: 52.8% by clinical visit, 44.2% by telephone contact and 3.0% by contact with the general practitioner. At 12-months, the success rate with or without antiarrhythmic drugs (AADs) was 73.6%. A significant portion (46%) was still on AADs. Late complications included 14 additional deaths (4 cardiac, 4 vascular, 6 other causes) and 333 (10.7%) other complications. AFib ablation in clinical practice is mostly performed in symptomatic, relatively young and otherwise healthy patients. Overall success rate is satisfactory, but complication rate remains considerable and a significant portion of patients remain on AADs. Monitoring after ablation shows wide variations. Antithrombotic treatment after ablation shows insufficient guideline-adherence.