title: Improved outcomes and complications of atrial fibrillation catheter ablation over time: learning curve, techniques, and methodology.
abstract: OBJECTIVE
  The outcomes of atrial fibrillation ablation procedures vary widely between different centers. Our objective was to analyze the results and complications of this procedure in our center and identify factors predicting the efficacy and safety of atrial fibrillation ablation.
  
  
  METHODS
  In total, 726 atrial fibrillation ablation procedures were performed in our center between 2002 and 2009. Beginning in January 2008, a protocol for anticoagulation and conscious sedation was systematically applied. Outcomes and complications could therefore be compared in 2 well-differentiated groups: group A included 419 procedures performed prior to 2008 and group B included 307 procedures completed after 2008 using the new protocol.
  
  
  RESULTS
  During an average follow-up of 8.7 months, 60.9% of patients were arrhythmia-free after one or repeat procedures. After only 1 procedure, the success rate was 41% and significantly higher in group B (51.6% vs 35.2% in group A; P=.001). There were 31 major complications (4.2%), 26 in group A (6.2%) and 5 in group B (1.6%) (P=.002). The implementation of the new protocol was an independent predictor of the absence of complications (odds ratio=0.406; 95% confidence interval, 0.214-0.769; P<.006).
  
  
  CONCLUSIONS
  Systematic application of an anticoagulation and conscious sedation protocol is associated with improved results and fewer complications of atrial fibrillation ablation. Factors not evaluated in the present study, such as operator experience and ongoing improvements in atrial fibrillation ablation technology, could have influenced these findings.
authors: Sección de Arritmias, Servicio de Cardiología, Institut del Tòrax, Hospital Clínic Universitari de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer, Facultat de Medicina de Universitat de Barcelona, Barcelona, Spain.
authors: Naiara
authors: N
authors: Calvo
authors: Mercè
authors: M
authors: Nadal
authors: Antonio
authors: A
authors: Berruezo
authors: David
authors: D
authors: Andreu
authors: Elena
authors: E
authors: Arbelo
authors: Jose Maria
authors: JM
authors: Tolosana
authors: Eduard
authors: E
authors: Guasch
authors: Maria
authors: M
authors: Matiello
authors: Maria
authors: M
authors: Matas
authors: Xavier
authors: X
authors: Alsina
authors: Marta
authors: M
authors: Sitges
authors: Josep
authors: J
authors: Brugada
authors: Lluís
authors: L
authors: Mont
mesh_terms: D000368:Aged; D000777:Anesthetics; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D016292:Procedural Sedation; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics; D000925:Anticoagulants; D006993:Hypnotics and Sedatives