Secular trends in success rate of catheter ablation for atrial fibrillation: The SMASH-AF cohort

Abstract

Background Approaches, tools, and technologies for atrial fibrillation (AF) ablation have evolved significantly since its inception. We sought to characterize secular trends in AF ablation success rates. Methods We performed a systematic review and meta-analysis of AF ablation from January 1, 1990, to August 1, 2016, searching PubMed, Scopus, and Cochrane databases. Major exclusion criteria were insufficient outcome reporting and ablation strategies that were not prespecified and uniform. We stratified treatment arms by AF type (paroxysmal AF; nonparoxysmal AF) and analyzed single-procedure outcomes. Multivariate meta-regressions analyzed effects of study, patient, and procedure characteristics on success rate trends. Registered in PROSPERO (CRD42016036549). Results A total of 180 trials and observational studies with 28,118 patients met inclusion. For paroxysmal AF ablation studies, unadjusted success rate summary estimates ranged from 73.1% in 2003 to 77.1% in 2016, increasing by 0.9%/year (95% CI 0.4%−1.4%; P = .001; I2 = 90%). After controlling for study design and patient demographics, rate of improvement in success rate summary estimate increased (1.6%/year; 95% CI 0.9%−2.2%; P = .001; I2 = 87%). For nonparoxysmal AF ablation studies, unadjusted success rate summary estimates ranged from 70.0% in 2010 to 64.3% in 2016 (1.1%/year; 95% CI −1.3% to 3.5%; P = .37; I2 = 85%), with no improvement in multivariate analyses. Conclusions Despite substantial research investment and health care expenditure, improvements in AF ablation success rates have been incremental. Meaningful improvements may require major paradigm or technology changes, and evaluation of clinical outcomes such as mortality and quality of life may prove to be important going forward.

Repeat procedures for recurrent persistent atrial fibrillation: A propensity‐matched score comparison between left atrial linear ablation with radiofrequency and posterior wall isolation with the cryoballoon

“…Pulmonary vein isolation (PVI) has demonstrated to provide limited clinical benefit in patients with persistent atrial fibrillation (persAF) 1‐3 . Left atrial (LA) substrate modification is frequently performed in addition to redo pulmonary vein isolation with different energy modalities 4‐7 .…”

Esophageal injury associated with catheter ablation for atrial fibrillation: Determinants of risk and protective strategies

“…Catheter ablation (CA) has grown importance in the management of patients with symptomatic AF 6,7 . Over the last decade, several technological advances have largely contributed to an ever‐growing experience with the procedure, leading to improved symptom control, lower recurrence rates, and better safety profiles 8‐11 . Despite that, major complications are reported in 3.5% to 7.5% of the patients, among which cardiac, neurological, and vascular access complications are the most frequently encountered 11‐15 .…”

Molecular Insights in Atrial Fibrillation Pathogenesis and Therapeutics: A Narrative Review

“…However, a ‘’ceiling’’ for more durable long-term success (strictly defined as no occurrence of AF) seems to be reached. Success rates range between 65 and 78%, requiring an in-depth understanding of mechanistic links [ 5 ].…”