Improved Outcomes and Complications of Atrial Fibrillation Catheter Ablation Over Time: Learning Curve, Techniques, and Methodology

Calvo, Naiara; Nadal, M.; Berruezo, Antonio; Andreu, David; Arbelo, Elena; Tolosana, José Marı́a; Guasch, Eduard; Matiello, María; Matas, Mariona; Alsina, Xavier; Sitges, Marta; Brugada, Josép; Mont, Lluı́s

doi:10.1016/j.rec.2011.08.015

Cited by 15 publications

(12 citation statements)

References 22 publications

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“…Despite the meticulous matching and model adjustment to ensure the balance of baseline risks and medical resource utilization, some residual bias might still exist because of unmeasured covariates. 22 AF contributes to loss of atrial systole, left ventricular systolic dysfunction, and aggravation of mitral regurgitation. Thus, elimination of AF with RFA might reduce HF symptoms.…”

Section: Discussionmentioning

confidence: 99%

Effect of Radiofrequency Catheter Ablation for Atrial Fibrillation on Morbidity and Mortality

Chang

Lin

Chiu

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background— This study examined the effect of radiofrequency catheter ablation (RFA) on reducing morbidity and mortality among patients with atrial fibrillation (AF). Methods and Results— A retrospective cohort of patients with AF without prior stroke or heart failure (HF) who underwent RFA between 2003 and 2009 was identified using Taiwan’s National Health Insurance claims database. Outpatients with AF who met the same enrollment criteria but did not receive RFA were matched (≤1:20) by hospitals and dates to serve as controls. Outcomes of interest were death, stroke, or hospitalization for HF. A proportional hazard Cox regression model adjusted by propensity scores (based on age, sex, hypertension, diabetes mellitus, comorbidities, medications, and medical resource utilization) was applied to estimate the hazard ratio and 95% confidence interval. A total of 846 patients with AF who received RFA and 11 324 matched AF controls were included, with a mean follow-up of 3.74 and 3.96 years, respectively. RFA was associated with a lower hazard for stroke (hazard ratio, 0.57; 95% confidence interval, 0.35–0.94; P =0.026). The reduction in the hazard for death and HF did not reach statistical significance (hazard ratio, 0.88; 95% confidence interval, 0.62–1.23; P =0.451 and hazard ratio, 0.78; 95% confidence interval, 0.55–1.12; P =0.185, respectively). Additional analysis using death as a competing risk showed similar results for stroke and HF. Conclusions— RFA did not reduce mortality or hospitalization for HF during the immediate 3.5-year follow-up. Although a beneficial effect on stroke prevention associated with RFA was suggested, residual confounding attributable to unmeasured factors remains a concern.

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Section: Discussionmentioning

confidence: 99%

Effect of Radiofrequency Catheter Ablation for Atrial Fibrillation on Morbidity and Mortality

Chang

Lin

Chiu

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…46 Jogging, but not other sporting activities, increased risk of AF in a large study. 22 A subanalysis of the FUTURE study 47 in patients with lone AF yielded an odds ratio of 9 for AF in endurance sports practitioners in comparison to team sports. To date, there has not been any studies showing an increased incidence AF in strength sport practitioners.…”

Section: [H2] Exercise-induced Afmentioning

confidence: 99%

Diagnosis, pathophysiology, and management of exercise-induced arrhythmias

Guasch

Mont

2016

Nat Rev Cardiol

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The cardiovascular benefits of physical activity are indisputable. Nevertheless, growing evidence suggests that both atrial fibrillation and right ventricular arrhythmia can be caused by intense exercise in some individuals. Exercise-induced atrial fibrillation is most commonly diagnosed in middle-aged, otherwise healthy men who have been engaged in endurance training for >10 years, and is mediated by atrial dilatation, parasympathetic enhancement, and possibly atrial fibrosis. Cardiac ablation is evolving as a first-line tool for athletes with exercise-induced arrhythmia who are eager to remain active. The relationship between physical activity and right ventricular arrhythmia is complex and involves genetic and physical factors that, in a few athletes, eventually lead to right ventricular dilatation, followed by subsequent myocardial fibrosis and lethal ventricular arrhythmias. Sinus bradycardia and atrioventricular conduction blocks are common in athletes, most of whom remain asymptomatic, although incomplete reversibility has been shown after exercise cessation. In this Review, we summarize the evidence supporting the existence of exercise-induced arrhythmias and discuss the specific considerations for the clinical management of these patients.

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“…The complications of this procedure vary widely, with most studies suggesting major complication rates between 1% and 8%. 2,[6][7][8][9][10][11][12] The majority of data regarding the safety of AF ablation comes from selected academic centers and operators with extensive expertise in catheter ablation. Real-world data regarding complications of AF ablation are limited.…”

mentioning

confidence: 99%

In-Hospital Complications Associated With Catheter Ablation of Atrial Fibrillation in the United States Between 2000 and 2010

et al. 2013

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Background-Atrial fibrillation ablation has made tremendous progress with respect to innovation, efficacy, and safety.However, limited data exist regarding the burden and trends in adverse outcomes arising from this procedure. The aim of our study was to examine the frequency of adverse events attributable to atrial fibrillation (AF) ablation and the influence of operator and hospital volume on outcomes. Methods and Results-With the use of the Nationwide Inpatient Sample, we identified AF patients treated with catheter ablation. We investigated common complications including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, vascular access complications (hemorrhage/hematoma, vascular complications requiring surgical repair, and accidental arterial puncture), and in-hospital death described with AF ablation, and we defined these complications by using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. An estimated 93 801 AF ablations were performed from 2000 to 2010. The overall frequency of complications was 6.29% with combined cardiac complications (2.54%) being the most frequent. Cardiac complications were followed by vascular complications (1.53%), respiratory complications (1.3%), and neurological complications (1.02%). The in-hospital mortality was 0.46%. Annual operator (<25 procedures) and hospital volume (<50 procedures) were significantly associated with adverse outcomes. There was a small (nonsignificant) rise in overall complication rates. Conclusions-The overall complication rate was 6.29% in patients undergoing AF ablation. There was a significant association between operator and hospital volume and adverse outcomes. This suggests a need for future research into identifying the safety measures in AF ablations and instituting appropriate interventions to improve overall AF ablation outcomes.

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Improved Outcomes and Complications of Atrial Fibrillation Catheter Ablation Over Time: Learning Curve, Techniques, and Methodology

Cited by 15 publications

References 22 publications

Effect of Radiofrequency Catheter Ablation for Atrial Fibrillation on Morbidity and Mortality

Effect of Radiofrequency Catheter Ablation for Atrial Fibrillation on Morbidity and Mortality

Diagnosis, pathophysiology, and management of exercise-induced arrhythmias

In-Hospital Complications Associated With Catheter Ablation of Atrial Fibrillation in the United States Between 2000 and 2010

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