Good Results with Catheter Ablation in Afib

JANUARY 20, 2017
Colleen Hall

More than half of patients with atrial fibrillation (AF) become asymptomatic after catheter ablation, reports the largest study of the procedure published today in European Heart Journal.1

Catheter ablation is the recommended treatment for AF patients with symptoms who still have an abnormal heart rhythm despite taking antiarrhythmic drugs. During the procedure, a long wire is threaded through the blood vessels into the heart and used to burn or freeze small areas of the atrium. This creates a scar and destroys or fences off abnormal electrical signals to stop them causing AF.

The paper reveals the in-hospital and one-year outcomes and management of 3630 AF patients treated with catheter ablation in Europe, the Middle East, and North Africa. The observational study of real life clinical practice was conducted by the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC) under the EURObservational Research Programme (EORP).

Symptoms significantly reduced after ablation, with more than half of patients becoming completely asymptomatic.

“This is good news for patients,” lead author Elena Arbelo, a senior specialist in the Arrhythmia Unit – Cardiovascular Institute, Hospital Clínic de Barcelona, Spain said in a press release. “According to our registry, 91% of patients choose to undergo an ablation for relief of symptoms and 66% to improve their quality of life.”

After the procedure, patients with 2 or more stroke risk factors should be prescribed oral anticoagulants, while those with no risk factors should not receive them. But the study found that 27% of patients with two or more risk factors were not anticoagulated, while one-third of low risk patients were receiving the drugs.

Catheter ablation was successful in 74% of patients, meaning that they had no atrial arrhythmias between 3 and 12 months after the procedure. Atrial arrhythmias in the first three months were classified as early recurrences and not considered as failure. Some 45% of patients who had a successful procedure were still on antiarrhythmic drugs at 12 months.

Regarding monitoring after the procedure, 83% of patients had at least one cardiology evaluation and 86% had at least one electrocardiogram (ECG). However, just 60% of patients had the recommended serial ECGs and multiday ECG recordings to check for recurrent AF.

Complication rates were 8% in-hospital and 11% during the one-year follow up. 

References
1. Arbelo E, et al. Contemporary management of patients undergoing atrial fibrillation ablation: in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry. Eur Heart J. 2017.  https://doi.org/10.1093/eurheartj/ehw564



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