title: Trends in atrial fibrillation ablation: have we maximized the current paradigms?
abstract: OBJECTIVE
  The purpose of this study was to evaluate how atrial fibrillation (AF) ablation has evolved over time with regards to patient characteristics, procedural variables, complications, and outcomes.
  
  
  METHODS
  We evaluated trends over time from 2003 to 2010 in clinical characteristics, procedural variables, complications, and Kaplan-Meier AF-free rates after the initial and final AF ablation in 1,125 patients undergoing 1,504 ablations.
  
  
  RESULTS
  Evaluating trends from 2003 to 2010, we found that patients undergoing AF ablation became older (P < 0.0001), had higher CHADS(2) scores (P < 0.0001), and more coronary artery disease (P = 0.021), persistent AF (P < 0.0001), hypertension (P < 0.0001), and previous strokes/transient ischemic attacks (P = 0.005). Procedure times decreased from 256 ± 49 to 122 ± 28 min (P < 0.0005), fluoroscopy times decreased from 134 ± 29 to 56 ± 19 min (P < 0.0005), and major (P = 0.023), minor (P = 0.023), and total complications (P = 0.001) decreased over time. The learning curve to minimize complications was 6 years. For paroxysmal AF, initial ablation AF-free rates improved over time (P = 0.015) but improvement plateaued in recent years. For persistent AF, initial ablation AF-free rates trended toward improvement over time (P = 0.062) but also plateaued in recent years. For long-standing persistent AF (P = 0.995), there was no outcome improvement after initial ablation over time. There was no trend for improved final outcomes (including repeat ablations) over time for paroxysmal, persistent, or long-standing AF (P = 0.150 to P = 0.978).
  
  
  CONCLUSIONS
  Despite decreased procedural and fluoroscopy times and reduced complication rates, post-ablation freedom from AF has not improved commensurately in recent years. A better understanding of AF initiation and maintenance may be required to devise personalized approaches to AF ablation and further improve outcomes.
authors.affiliation: Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA 94303, USA. rawinkle@aol.com
authors.forename: Roger A
authors.initials: RA
authors.lastname: Winkle
authors.forename: R Hardwin
authors.initials: RH
authors.lastname: Mead
authors.forename: Gregory
authors.initials: G
authors.lastname: Engel
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Kong
authors.forename: Rob A
authors.initials: RA
authors.lastname: Patrawala
mesh_terms: D001281:Atrial Fibrillation / Q000401:mortality* / Q000601:surgery*; D002140:California / Q000453:epidemiology; D017115:Catheter Ablation / Q000401:mortality* / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome