Safety and patient-reported outcomes in index ablation versus repeat ablation in atrial fibrillation: insights from the German Ablation Registry

Abstract

Background Pulmonary vein isolation is an established strategy for catheter ablation of atrial fibrillation (AF). However, in a significant number of patients, a repeat procedure is mandatory due to arrhythmia recurrence. In this study, we report safety data and procedural details of patients undergoing index ablation versus repeat ablation in a registry-based real-life setting. Methods Patients from the German Ablation Registry, a prospective, multicentre registry of patients undergoing ablation between January 2007 and January 2010 were included. Results A total of 4155 patients were enrolled in the study. Group I (index ablation) consisted of 3377/4155 (82.1%) and group II (repeat ablation) of 738/4155 (17.9%). Patients in group I had a significantly higher ratio of paroxysmal AF (69.3% vs 61.9%, p < 0.001) and significantly less persistent AF (30.7% vs 38.1%, p < 0.001). The repeat group showed significantly lower mean RF application duration (2580 s. vs 1960, p < 0.001), less fluoroscopy time (29 min. vs. 27 min., p < 0.001), less mean dose area product (DAP) (3744 cGy × cm2 vs 3325 cGy × cm2, p = 0.001), and shorter study duration (181.2 min. vs 163.6 min., p < 0.001). No statistical difference between the groups was found in terms of mortality (0.3% vs 0.1%, p = 0.39), MACE (0.4% vs 0.3%, p = 0.58), MACCE (0.8% vs 0.6%, p = 0.47), composite safety endpoint (1.5% vs 1.4%, p = 0.76), and arrhythmia recurrence (43.8% vs 41.9%, p = 0.37) during 1-year follow-up. Both groups reported to have improved or no symptoms (80.4% vs 77.8%, p = 0.13). Conclusion Repeat catheter ablation is safe and provides a symptomatic relief comparable to index ablation. Repeat procedures are significantly shorter and use less fluoroscopy.

Does Preoperative Sinus Rhythm Influence Surgical Ablation’s Perioperative Safety in Patients with Atrial Fibrillation?

“…Moreover, we observe the same for stroke and MACCE [Mack 2019;Mäkikallio 2016;Popma 2019;Serruys 2009;Stone 2016]. Also, no patient in our SR-group suffered a complication, which are more likely to occur in interventional ablations (where it is around 0.5%, i.e., pulmonary vein injury or stenosis, phrenic nerve palsy, vena cava, or esophageal injury [Kany 2021;Rottner 2021;Zylla 2020]). In addition, only 0.3% of patients in the SR group had a pulmonary embolism.…”

The impact of basic atrial rhythm during catheter ablation of atrial fibrillation on clinical outcomes: Lessons from the German Ablation Registry

“…In general, data on the incidence of complications of RF‐versus CB‐based ablation and more complex ablation as compared with stand‐alone PVI are conflicting. While several studies have shown similar complication rates for more complex ablation strategies, 3,4,10 others describe enhanced rates of cardiac tamponade 11 or of minor and major complications in general 12 . Furthermore, PVI guided by balloon systems might be associated with a lower risk of tamponades as compared to point‐by‐point RF‐ablation 11 .…”

Antiarrhythmic drug therapy after catheter ablation for atrial fibrillation—Insights from the German Ablation Registry

“…A study by Kany et al found that patient satisfaction was similar after primary and reablation procedures. 19 This leads to the conclusion…”

“…A study by Kany et al found that patient satisfaction was similar after primary and reablation procedures. 19 This leads to the conclusion that at least in the group of patients with pAF postinterventional AAD might reduce treatment satisfaction. Patients with persAF are possibly more used to medication use (due to a higher number of comorbidities) and were not so much bothered by additional drug treatment.…”