Nationwide Survey of Catheter Ablation for Atrial Fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF)

Abstract

Background: A nationwide survey of catheter ablation for atrial fibrillation (AF) was conducted in Japan to determine the mid-term performance of the therapy from analysis of the 1-year outcome of registered patients. Methods and Results:A total of 2,137 patients who underwent AF ablation in September 2011 and March 2012 were initially registered. In 2013, the 1-year follow-up data of 1,208 patients (56.5% of 2,137) from 119 centers were collected. Average age was 61.9±10.7 years. Patients with paroxysmal AF (PAF) constituted 64.3%. Persistent AF (pAF) and long-standing pAF (LS-pAF) were 20.4% and 15.3%, respectively. For all patients, 76.7% underwent their first AF ablation. At 1 year after AF ablation, 70.9%, 61.4%, and 56.2% of PAF, pAF, and LS-pAF patients, respectively, were free from AF or clinical/partial success (PAF vs. pAF or LS-pAF: P<0.01). Re-ablation was performed in 11.3%, 16.3%, and 17.3%, respectively. Multivariate logistic regression analysis revealed that procedure time (odds ratio [OR] 0.82, P=0.000), and results of AF induction test (OR 1.36, P<0.02) were significantly related to successful outcome. Statistical AnalysisContinuous variables with a normal distribution are expressed as the mean ± SD. The comparison of categorical variables was done using Tukey's test. Kaplan-Meier curves of AF-free survival were generated. Comparisons between PAF and nonPAF patients were done by 2-sided log-rank test. Logistic regression analysis was applied to determine how each clinical variable related to the outcome. Variables with a P value <0.1 in the univariate analysis were selected for multivariate logistic regression analysis. In addition, patients with PAF and those with nonPAF were separately analyzed to assess whether predictive factors for the mid-term outcome of AF ablation varied among the different AF types. Relative risks are expressed as odds ratio (OR) with 95% confidence interval (CI). P<0.05 was considered statistically significant. Results Comparison of Clinical BackgroundsIn total, 158 institutes reported their data of AF ablation. A total of 2,137 cases were registered and 1-year follow-up data were obtained for 1,208 of them from 119 centers. Average patient age was 61.9±10.7 years, and 76.7% (n=927) were male. Of all sessions, 76.3% were first AF ablations, 20.2% were second sessions, and 3.5% were subsequent sessions. Patients with PAF constituted 64.3% (n=777), while pAF and LS-pAF were 20.4% and 15.3% (n=246 and 185), respectively. Clinical profiles of the 3 AF types are shown in Table 1. Left ventricular ejection fraction in PAF patients was greater than that of nonPAF subjects. Left atrial diameter (LAd) in PAF patients was smaller than in nonPAF patients.

Readmissions and repeat procedures after catheter ablation for atrial fibrillation

“…Our results are comparable with these reported in other registries [5,6]. Shah et al [5] identified 22% AF readmission rate and almost 40% rehospitalization rate in AF ablation patients in California in a 1-year follow-up.…”

“…In the same study, 30-day all-cause readmission rate was 10%. In the J-CARAF study, ablation was successful in approximately 70% of paroxysmal AF patients and 60% of non-paroxysmal AF in a 1-year after the index procedure [6].…”

Current Status of Catheter Ablation for Atrial Fibrillation

“…Precise information on AAD therapy will be reported in another article. 10 In this survey, the number of patients who had paroxysmal AF attack less than once per month but who received ablation increased significantly during the survey period (Figure 1). This might indicate that application of AF ablation was expanding to patients with infrequent paroxysmal AF attacks.…”

Effect of radiofrequency catheter ablation of persistent atrial fibrillation on the left atrial function: Assessment by 320-row multislice computed tomography

“…In the last decade, radiofrequency catheter ablation (RFCA) has achieved satisfactory results, and stable sinus rhythm without any antiarrhythmic drugs can be maintained in up to 50-60% of patients with persistent AF during mid-to long-term follow-up [2,3]. Furthermore, LA reverse remodeling is often seen when stable sinus rhythm is achieved [4][5][6][7][8].…”