Temporal trends in the availability and efficacy of catheter ablation for atrial fibrillation and atrial flutter in a highly populated urban area

Abstract

Background: Pulmonary vein isolation has become one of the core modalities of the rhythm control strategy in patients with atrial fibrillation (AF).

Aims: The aim of the study was to analyze temporal trends in the availability and efficacy of AF and atrial flutter (AFL) catheter ablation in an urban area of Upper Silesia in Poland.

Methods: The source data were obtained from the SILCARD (Silesian Cardiovascular Database) covering an adult population of 3.8 million. The final study population included patients with diagnosis code I48 referred for catheter ablation between 2006 and 2017. The data included total number of procedures, patient sex, age, comorbidities, number of hospital admissions, and mortality rate.

Results: A total of 2745 patients were enrolled. The number of ablated patients increased more than 10‑fold (43 in 2006 vs 507 in 2017; P = 0.008) in the follow‑up period. The analysis showed an upward trend in the proportion of women (P = 0.02), hypertension prevalence (P = 0.004), and percentage of patients implanted (P = 0.02). A decrease was observed in the percentage of patients with stable angina (P <0.005) and hospitalization length (P <0.005). The all‑cause hospital readmissions rate decreased from 55.8% to 25.4% (P <0.005). There were significant reductions in the 12‑month all‑cause mortality (2.3% in 2006 vs 0.2% in 2017; P <0.005), stroke (2.3% in 2006 vs 0.2% in 2017; P = 0.047), and myocardial infarction rates (2.3% in 2006 vs 0.4% in 2017; P = 0.03).

Conclusions: A considerable increase in the availability and efficacy of AF / AFL ablations was documented over the 12‑year follow‑up period.

Keywords: atrial fibrillation; catheter ablation; pulmonary vein isolation; registry.