Patient selection, peri-procedural management, and ablation techniques for catheter ablation of atrial fibrillation: an EHRA survey

Abstract

Catheter ablation (CA) of atrial fibrillation (AF) is the therapy of choice for the maintenance of sinus rhythm in patients with symptomatic AF. Time towards interventional treatment and peri-procedural management of patients undergoing AF ablation may vary in daily practice. The scope of this European Heart Rhythm Association (EHRA) survey was to report the current clinical practice regarding the management of patients undergoing AF ablation and physician’s adherence to the European Society of Cardiology Guidelines and the EHRA/HRS/ECAS expert consensus statement on the CA for AF. This physician-based survey was conducted among EHRA members, using an internet-based questionnaire developed by the EHRA Scientific Initiatives Committee. A total of 258 physicians participated in the survey. In patients with paroxysmal or persistent AF, 42 and 9% of the physicians would routinely perform AF ablation as first-line therapy respectively, whereas 71% of physicians would consider ablation as first-line therapy in patients with symptomatic AF and left ventricular ejection fraction <35%. Only 14% of the respondents manage cardiovascular risk factors in patients referred for CA using a dedicated AF risk factor management programme. Radiofrequency CA is the preferred technology for first-time AF (56%), followed by cryo-balloon CA (40%). This EHRA survey demonstrated a considerable variation in the management of patients undergoing AF ablation in routine practice and deviations between guideline recommendations and clinical practice.

Utilization of 3D mapping systems in interventional electrophysiology and its impact on procedure time and fluoroscopy—Insights from the “Go for Zero Fluoroscopy” project

“…In case of ablation of atrial fibrillation, recent studies have shown the feasibility and safety of a zero or low fluoroscopy approach 16–19 . In a meta‐analysis of Huang et al.…”

“…In case of ablation of atrial fibrillation, recent studies have shown the feasibility and safety of a zero or low fluoroscopy approach. [16][17][18][19] In a meta-analysis of Huang et al including 2228 procedures, use of 3D mapping in order to achieve zero or low fluoroscopy exposure led to lower fluoroscopy time and DAP. This finding was confirmed in the present study as well, although not reaching statistical significance.…”

Best Practice Guide for Cryoballoon Ablation in Atrial Fibrillation: The Compilation Experience of More than 1000 Procedures

“…The second-generation cryoballoon (CB) (Arctic FrontTM, Medtronic Inc, Minneapolis, MN), released in 2012, achieved more uniform cooling across the entire distal hemisphere of the balloon using 8 instead of 4 injection tubes [ 4 , 5 ] considerably improving the acute results of PVI as well as the long-term efficacy in diverse clinical settings [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Nowadays, the CB constitutes an established alternative to radio frequency (RF) ablation for PVI [ 1 , 15 ], which offers the possibility to isolate the PVs with a single application.…”

A novel saline-based occlusion tool allows for dye-less cryoballoon-based pulmonary vein isolation and fluoroscopy reduction

“…In addition, early rhythm control has been shown to be favorable in the reduction of cardiovascular events in the main cohort of the EAST-AFNET 4 trial and in subgroup analyses (2,3). Therefore, the most effective rhythm control strategy, which is catheter ablation is gaining more and more importance (4). Within this context, cryoballoon (CB) based AF ablation plays a major role as a first-line ablation tool because of its safety (5), high reproducibility (6) and efficacy (7,8).…”