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. 2019 Mar 7;40(10):820-830.
doi: 10.1093/eurheartj/ehy709.

A decade of catheter ablation of cardiac arrhythmias in Sweden: ablation practices and outcomes

Fredrik Holmqvist  1 , Milos Kesek  2 , Anders Englund  3 , Carina Blomström-Lundqvist  4 , Lars O Karlsson  5 , Göran Kennebäck  6 , Dritan Poçi  7 , Romeo Samo-Ayou  8 , Runa Sigurjónsdóttir  9 , Michael Ringborn  10 , Csaba Herczku  11 , Jonas Carlson  1 , Espen Fengsrud  7 , Fariborz Tabrizi  3 , Niklas Höglund  2 , Stefan Lönnerholm  4 , Ole Kongstad  1 , Anders Jönsson  5 , Per Insulander  6
Affiliations

A decade of catheter ablation of cardiac arrhythmias in Sweden: ablation practices and outcomes

Fredrik Holmqvist et al. Eur Heart J. .

Abstract

Aims: Catheter ablation is considered the treatment of choice for many tachyarrhythmias, but convincing 'real-world' data on efficacy and safety are lacking. Using Swedish national registry data, the ablation spectrum, procedural characteristics, as well as ablation efficacy and reported adverse events are reported.

Methods and results: Consecutive patients (≥18 years of age) undergoing catheter ablation in Sweden between 01 January 2006 and 31 December 2015 were included in the study. Follow-up (repeat ablation and vital status) was collected through 31 December 2016. A total of 26 642 patients (57 ± 15 years, 62% men), undergoing a total of 34 428 ablation procedures were included in the study. In total, 4034 accessory pathway/Wolff-Parkinson-White syndrome (12%), 7358 AV-nodal re-entrant tachycardia (21%), 1813 atrial tachycardia (5.2%), 5481 typical atrial flutter (16%), 11 916 atrial fibrillation (AF, 35%), 2415 AV-nodal (7.0%), 581 premature ventricular contraction (PVC, 1.7%), and 964 ventricular tachycardia (VT) ablations (2.8%) were performed. Median follow-up time was 4.7 years (interquartile range 2.7-7.0). The spectrum of treated arrhythmias changed over time, with a gradual increase in AF, VT, and PVC ablation (P < 0.001). Decreasing procedural times and utilization of fluoroscopy with time, were seen for all arrhythmia types. The rates of repeat ablation differed between ablation types, with the highest repeat ablation seen in AF (41% within 3 years). The rate of reported adverse events was low (n = 595, 1.7%). Death in the immediate period following ablation was rare (n = 116, 0.34%).

Conclusion: Catheter ablations have shifted towards more complex procedures over the past decade. Fluoroscopy time has markedly decreased and the efficacy of catheter ablation seems to improve for AF.

Keywords: Adverse events; Catheter ablation; Outcome.

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Figures

Figure 1
Figure 1
Types of catheter ablations in Sweden between 2006 and 2015. P < 0.0001 (Pearson χ2). AF, ablation of atrial fibrillation; AT, ablation of atrial tachycardia; AVN, AV-nodal ablation; AVNRT, AV-nodal re-entry tachycardia ablation; AP/WPW, accessory pathway/Wolff–Parkinson–White syndrome; CTI, cavotricuspid isthmus ablation; PVC, ablation of premature ventricular contraction; VT, ablation of ventricular tachycardia.
Figure 2
Figure 2
(A) Median procedure time, by ablation type and treatment year. (B) Median fluoroscopy time, by ablation type and treatment year. (C) Acute success, by ablation type and treatment year. (D) Median radiation dose, by ablation type and treatment year. *P < 0.001 (independent sample Kruskal–Wallis test); †P = 0.005 (independent sample Kruskal–Wallis test); ‡P = 0.001 (independent sample Kruskal–Wallis test); #P = 0.023 (Mantel–Haenzsel test for trend). AF, ablation of atrial fibrillation; AT, ablation of atrial tachycardia; AVN, AV-nodal ablation; AVNRT, AV-nodal re-entry tachycardia ablation; AP/WPW, accessory pathway/Wolff–Parkinson–White syndrome; CTI, cavotricuspid isthmus ablation; PVC, ablation of premature ventricular contraction; VT, ablation of ventricular tachycardia.
Figure 3
Figure 3
Cumulative incidence function plot illustrating the probability of repeat ablation (same arrhythmia) after a de novo ablation. Numbers at risk are illustrated in the accompanying table. AF, ablation of atrial fibrillation; AVN, AV-nodal ablation; AVNRT, AV-nodal re-entry tachycardia ablation; AP/WPW, accessory pathway/Wolff–Parkinson–White syndrome; CTI, cavotricuspid isthmus ablation; PVC, ablation of premature ventricular contraction; VT, ablation of ventricular tachycardia.
Figure 4
Figure 4
Rate of repeat ablation (for the same substrate) in de novo ablations with acutely successful result (as judged by the operator by the end of the procedure), by arrhythmia substrate and year of index procedure. The thicker line represents the rate of repeat ablation within 1 year of the index procedure, whereas the thinner lines represent the rate of repeat ablation within 3 years of the index procedure. Analyses for trend was performed using Mantel–Haenzsel test for trend. AF, ablation of atrial fibrillation; AT, ablation of atrial tachycardia; AVN, AV-nodal ablation; AVNRT, AV-nodal re-entry tachycardia ablation; AP/WPW, accessory pathway/Wolff–Parkinson–White syndrome; CTI, cavotricuspid isthmus ablation; PVC, ablation of premature ventricular contraction; VT, ablation of ventricular tachycardia.
See this image and copyright information in PMC

Comment in

  • Catheter ablation: an ongoing revolution.
    Raymond-Paquin A, Andrade J, Macle L. Raymond-Paquin A, et al. J Thorac Dis. 2019 Mar;11(Suppl 3):S212-S215. doi: 10.21037/jtd.2019.02.20. J Thorac Dis. 2019. PMID: 30997179 Free PMC article. No abstract available.

References

    1. Gallagher JJ, Svenson RH, Kasell JH, German LD, Bardy GH, Broughton A, Critelli G.. Catheter technique for closed-chest ablation of the atrioventricular conduction system. N Engl J Med 1982;306:194–200. - PubMed
    1. Borggrefe M, Budde T, Podczeck A, Breithardt G.. High frequency alternating current ablation of an accessory pathway in humans. J Am Coll Cardiol 1987;10:576–582. - PubMed
    1. Haïssaguerre M, Jaïs P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Métayer P, Clémenty J.. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659–666. - PubMed
    1. Stevenson WG, Delacretaz E, Friedman PL, Ellison KE.. Identification and ablation of macroreentrant ventricular tachycardia with the CARTO electroanatomical mapping system. Pacing Clin Electrophysiol 1998;21:1448–1456. - PubMed
    1. Novak PG, Macle L, Thibault B, Guerra PG.. Enhanced left atrial mapping using digitally synchronized NavX three-dimensional nonfluoroscopic mapping and high-resolution computed tomographic imaging for catheter ablation of atrial fibrillation. Heart Rhythm 2004;1:521–522. - PubMed

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