The atrial fibrillation ablation pilot study: a European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association.
OBJECTIVE
The Atrial Fibrillation Ablation Pilot Study is a prospective registry designed to describe the clinical epidemiology of patients undergoing an atrial fibrillation (AFib) ablation, and the diagnostic/therapeutic processes applied across Europe. The aims of the 1-year follow-up were to analyse how centres assess in routine clinical practice the success of the procedure and to evaluate the success rate and long-term safety/complications.


RESULTS
Seventy-two centres in 10 European countries were asked to enrol 20 consecutive patients undergoing a first AFib ablation procedure. A web-based case report form captured information on pre-procedural, procedural, and 1-year follow-up data. Between October 2010 and May 2011, 1410 patients were included and 1391 underwent an AFib ablation (98.7%). A total of 1300 patients (93.5%) completed a follow-up control 367 ± 42 days after the procedure. Arrhythmia documentation was done by an electrocardiogram in 76%, Holter-monitoring in 52%, transtelephonic monitoring in 8%, and/or implanted systems in 4.5%. Over 50% became asymptomatic. Twenty-one per cent were re-admitted due to post-ablation arrhythmias. Success without antiarrhythmic drugs was achieved in 40.7% of patients (43.7% in paroxysmal AF; 30.2% in persistent AF; 36.7% in long-lasting persistent AF). A second ablation was required in 18% of the cases and 43.4% were under antiarrhythmic treatment. Thirty-three patients (2.5%) suffered an adverse event, 272 (21%) experienced a left atrial tachycardia, and 4 patients died (1 haemorrhagic stroke, 1 ventricular fibrillation in a patient with ischaemic heart disease, 1 cancer, and 1 of unknown cause).


CONCLUSIONS
The AFib Ablation Pilot Study provided crucial information on the epidemiology, management, and outcomes of catheter ablation of AFib in a real-world setting. The methods used to assess the success of the procedure appeared at least suboptimal. Even in this context, the 12-month success rate appears to be somewhat lower to the one reported clinical trials.
Department of Cardiology, Thorax Institute, Hospital Clínic de Barcelona, C/ Villarroel 170, 6° - Escala 3, 08036, University of Barcelona, Barcelona, Spain elenaarbelo@secardiologia.es.
Elena
E
Arbelo
Department of Cardiology, Thorax Institute, Hospital Clínic de Barcelona, C/ Villarroel 170, 6° - Escala 3, 08036, University of Barcelona, Barcelona, Spain.
Josep
J
Brugada
Heart Center, University of Leipzig, Leipzig, Germany.
Gerhard
G
Hindricks
EURObservational Research Programme, European Society of Cardiology, Sophia - Antipolis, France.
Aldo P
AP
Maggioni
GVM Care and Research, E.S. Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy.
Luigi
L
Tavazzi
Department of Cardiology, Heraklion University Hospital, Crete, Greece.
Panos
P
Vardas
EURObservational Research Programme, European Society of Cardiology, Sophia - Antipolis, France.
Cécile
C
Laroche
Service De Cardiologie, Hôpital Charles Nicolle, Rouen Cedex, France.
Frédéric
F
Anselme
Ospedale Maggiore Di Crema, Crema, Italy.
Giuseppe
G
Inama
Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
Pierre
P
Jais
Department of Cardiology, Silesian Academy of Medicine, Zabrze, Poland.
Zbigniew
Z
Kalarus
Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
Josef
J
Kautzner
Department of Cardiology, Isar Heart Centre, Muenchen, Germany.
Thorsten
T
Lewalter
Cliniques du Sud Luxembourg - Vivalia, Arlon, Belgium.
Georges H
GH
Mairesse
Hospital Clinico San Carlos, Madrid, Spain.
Julian
J
Perez-Villacastin
AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Sam
S
Riahi
Internal Cardiology Department, Faculty Hospital Olomouc, Olomouc, Czech Republic.
Milos
M
Taborsky
Henry Dunant Hospital/Errikos Dynan Hospital, Athens, Greece.
George
G
Theodorakis
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Serge A
SA
Trines
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D004562:Electrocardiography; D006801:Humans; D053208:Kaplan-Meier Estimate; D010359:Patient Readmission / Q000706:statistics & numerical data; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods / Q000401:mortality; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents
Atrial fibrillation; Catheter ablation; Outcomes; Registry; Survey