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Multicenter Study
. 2020 Sep;13(9):e007944.
doi: 10.1161/CIRCEP.119.007944. Epub 2020 Jul 23.

Procedural Patterns and Safety of Atrial Fibrillation Ablation: Findings From Get With The Guidelines-Atrial Fibrillation

Zak Loring  1   2 , DaJuanicia N Holmes  1 , Roland A Matsouaka  1   3 , Anne B Curtis  4 , John D Day  5 , Nihar Desai  6 , Kenneth A Ellenbogen  7 , Gregory K Feld  8 , Gregg C Fonarow  9 , David S Frankel  10 , Jodie L Hurwitz  11 , Bradley P Knight  12 , Jose A Joglar  13 , Andrea M Russo  14 , Mandeep S Sidhu  15 , Mintu P Turakhia  16   17 , William R Lewis  18 , Jonathan P Piccini  1   2
Affiliations
Multicenter Study

Procedural Patterns and Safety of Atrial Fibrillation Ablation: Findings From Get With The Guidelines-Atrial Fibrillation

Zak Loring et al. Circ Arrhythm Electrophysiol. 2020 Sep.

Abstract

Background: Catheter ablation is an increasingly used treatment for symptomatic atrial fibrillation (AF). However, there are limited prospective, nationwide data on patient selection and procedural characteristics. This study describes patient characteristics, techniques, treatment patterns, and safety outcomes of patients undergoing AF ablation.

Methods: A total of 3139 patients undergoing AF ablation between 2016 and 2018 in the Get With The Guidelines-Atrial Fibrillation registry from 24 US centers were included. Patient demographics, medical history, procedural details, and complications were abstracted. Differences between paroxysmal and patients with persistent AF were compared using Pearson χ2 and Wilcoxon rank-sum tests.

Results: Patients undergoing AF ablation were predominantly male (63.9%) and White (93.2%) with a median age of 65. Hypertension was the most common comorbidity (67.6%), and patients with persistent AF had more comorbidities than patients with paroxysmal AF. Drug refractory, paroxysmal AF was the most common ablation indication (class I, 53.6%) followed by drug refractory, persistent AF (class I, 41.8%). Radiofrequency ablation with contact force sensing was the most common ablation modality (70.5%); 23.7% of patients underwent cryoballoon ablation. Pulmonary vein isolation was performed in 94.6% of de novo ablations; the most common adjunctive lesions included left atrial roof or posterior/inferior lines, and cavotricuspid isthmus ablation. Complications were uncommon (5.1%) and were life-threatening in 0.7% of cases.

Conclusions: More than 98% of AF ablations among participating sites are performed for class I or class IIA indications. Contact force-guided radiofrequency ablation is the dominant technique and pulmonary vein isolation the principal lesion set. In-hospital complications are uncommon and rarely life-threatening.

Keywords: atrial fibrillation; catheter ablation; guideline adherence; hypertension; pulmonary vein.

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Figures

Figure 1
Figure 1. Indications for Catheter Ablation:
Percentage of patients referred for catheter ablation for paroxysmal atrial fibrillation (AF) refractory to at least one antiarrhythmic drug (AAD), persistent AF refractory to at least one AAD, first line therapy for paroxysmal AF, and first line therapy for persistent AF.
Figure 2
Figure 2. Antiarrhythmic Use:
Frequency of antiarrhythmic use prior to catheter ablation subgrouped by atrial fibrillation (AF) subtype. P<0.0001 for all comparisons between paroxysmal and persistent AF.
Figure 3
Figure 3. Ablation Techniques for First Ablations:
Frequency of different ablation lesion sets for patients undergoing first ablations (N=2418) subgrouped by atrial fibrillation (AF) subtype. Abbreviations: PVI = pulmonary vein isolation; LA = left atrial; PW = posterior wall; CTI = cavotricuspid isthmus; SVC = superior vena cava; CFAE = complex fractionated atrial electrogram; FIRM = focal impulse and rotor modulation
Figure 4
Figure 4. Ablation Techniques for First Time vs Repeat Ablations:
Frequency of different ablation lesion sets for patients undergoing first time ablation (N=2418) vs repeat ablations (N=721). Abbreviations: PVI = pulmonary vein isolation; LA = left atrial; PW = posterior wall; CTI = cavotricuspid isthmus; SVC = superior vena cava; CFAE = complex fractionated atrial electrogram; FIRM = focal impulse and rotor modulation
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