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. 2023 Apr 23;39(3):366-375.
doi: 10.1002/joa3.12854. eCollection 2023 Jun.

Trends over the recent 6 years in ablation modalities and strategies, post-ablation medication, and clinical outcomes of atrial fibrillation ablation

Moyuru Hirata  1 , Koichi Nagashima  1 , Ryuta Watanabe  1 , Yuji Wakamatsu  1 , Naoto Otsuka  1 , Satoshi Hayashida  1 , Shu Hirata  1 , Masanaru Sawada  1 , Sayaka Kurokawa  1 , Yasuo Okumura  1
Affiliations

Trends over the recent 6 years in ablation modalities and strategies, post-ablation medication, and clinical outcomes of atrial fibrillation ablation

Moyuru Hirata et al. J Arrhythm. .

Abstract

Background: Ablation strategies and modalities for atrial fibrillation (AF) have transitioned over the past decade, but their impact on post-ablation medication and clinical outcomes remains to be fully investigated.

Methods: We divided 682 patients who had undergone AF ablation in 2014-2019 (420 paroxysmal AFs [PAF], 262 persistent AFs [PerAF]) into three groups according to the period, that is, the 2014-2015 (n = 139), 2016-2017 (n = 244), and 2018-2019 groups (n = 299), respectively.

Results: Persistent AF became more prevalent and the left atrial (LA) diameter larger over the 6 years. Extra-pulmonary vein (PV)-LA ablation was more frequently performed in the 2014-2015 group than in the 2016-2017 and 2018-2019 groups (41.1% vs. 9.1% and 8.1%; p < .001). The 2-year freedom rate from AF/atrial tachycardias for PAF was similar among the three groups (84.0% vs. 83.1% vs. 86.7%; p = .98) but lowest in the 2014-2015 group for PerAF (63.9% vs. 82.7% and 86.3%; p = .025) despite the highest post-ablation antiarrhythmic drug use. Cardiac tamponade was significantly decreased in the 2018-2019 group (3.6% vs. 2.0% vs. 0.33%; p = 0.021). There was no difference in the 2-year clinically relevant events among the three groups.

Conclusion: Although ablation was performed in a more diseased LA and extra-PV-LA ablation was less frequent in recent years, the complication rate decreased, and AF recurrences for PAF remained unchanged, but that for PerAF decreased. Clinically relevant events remained unchanged over the recent 6 years, suggesting that the impact of the recent ablation modalities and strategies on remote clinically relevant events may be small during this study period.

Keywords: atrial fibrillation; catheter ablation; clinical outcome.

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Conflict of interest statement

The following authors have potential conflicts of interest: YO has received research funding from Bayer Healthcare, Daiichi‐Sankyo, Bristol‐Meyers Squibb, Nippon Boehringer Ingelheim, Pfizer, and Boston Scientific Japan and has accepted remuneration from Bayer Healthcare, Daiichi‐Sankyo, and Bristol‐Meyers Squibb. KN has accepted remuneration from Johnson & Johnson K.K. The other authors have no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Ablation modality and strategy over 6 years. AI, ablation index; CFAE, complex fractionated atrial electrogram; EAT, epicardial tissue; FTI, force–time integral; LSI, lesion index.
FIGURE 2
FIGURE 2
Kaplan–Meier curves for the freedom from AF/AT after an initial ablation among the 2014–2015, 2016–2017, and 2018–2019 groups.
FIGURE 3
FIGURE 3
Kaplan–Meier curves for the cumulative incidence of clinically relevant events after an initial ablation among the 2014–2015, 2016–2017, and 2018–2019 groups.[Correction added on 29 April 2023 after first online publication: Figure 3 in the article is corrected in this version.]
See this image and copyright information in PMC

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