title: Regional differences in referral, procedures, and outcome after ablation for atrial fibrillation in Europe: a report from the Atrial Fibrillation Ablation Pilot Registry of the European Society of Cardiology.
abstract: OBJECTIVE
  Ablation is an effective treatment of symptomatic and drug refractory atrial fibrillation (AF). Using data from the European AF Ablation Pilot Registry comprising 1410 patients from 10 European countries, we prospectively investigated regional differences in AF ablation regarding patient selection, ablation strategy, and outcome.
  
  
  RESULTS
  Countries were divided into three regions: South (Greece, Italy, Spain), East (Czech Republic, Poland), and West/North (Belgium, Denmark, France, Germany, and the Netherlands). One-year success was defined as patient survival free from atrial arrhythmia, with or without antiarrhythmic drugs (AAD). In all regions, patients were symptomatic and treated extensively with beta-blockers and AAD pre-ablation. Patients in East had more co-morbidity, increased thromboembolic risk, were more likely to have paroxysmal AF, and they underwent more left atrial linear ablations. Adverse events remained within expected levels, albeit with a significantly higher reporting of adverse cardiovascular events in the West/North (4.7 vs. 1.4 and 1.5% in South and East, P = 0.0032). There was no significant difference in peripheral/vascular, neurological, pulmonary, gastrointestinal, or general adverse events. The 1-year success rate after ablation differed non-statistically between regions ranging from 69.1 to 74.7%. A second ablation was performed in 23.2% in West/North compared with 10.5 and 16.5% in South and East. The proportion of patients still on AADs was highest in the South region (51.6 vs. 42.3 and 38.8% in East and West/North).
  
  
  CONCLUSIONS
  This study with all-comer patients shows that patient selection for ablation follows current guidelines but reveals significant differences regarding co-morbidity, medication, and ablation strategy. Despite this, 1-year outcomes are without significant differences and in line with previously published clinical trials.
authors.affiliation: AF-Study Group, Department of Cardiology, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark sar@rn.dk.
authors.forename: Sam
authors.initials: S
authors.lastname: Riahi
authors.affiliation: Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Arbelo
authors.affiliation: Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.affiliation: EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France ANMCO Research Center, Florence, Italy.
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: GVM Care and Research, E.S. Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: Department of Cardiology, Heraklion University Hospital, Crete, Greece.
authors.forename: Panos
authors.initials: P
authors.lastname: Vardas
authors.affiliation: EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Laroche
authors.affiliation: Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: Michalis
authors.initials: M
authors.lastname: Efremidis
authors.affiliation: Department of Rythmology, CHU Dinant-Godinne UCL, Yvoir, Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: Xhaet
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Woźniak
authors.affiliation: Department of Cardiology, University of Groningen, Groningen, The Netherlands.
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: Van Gelder
authors.affiliation: AF-Study Group, Department of Cardiology, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark.
authors.forename: Soren
authors.initials: S
authors.lastname: Hjortshoj
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000639:trends*; D015897:Comorbidity; D018572:Disease-Free Survival; D005060:Europe / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D053208:Kaplan-Meier Estimate; D053685:Laser Therapy / Q000009:adverse effects / Q000639:trends*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000639:trends*; D017064:Process Assessment, Health Care / Q000639:trends*; D011446:Prospective Studies; D012008:Recurrence; D012017:Referral and Consultation / Q000639:trends*; D012042:Registries; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Ablation; Atrial fibrillation; Complications; Outcome; Registry