Temporal trends in atrial fibrillation recurrence rates after ablation between 2005 and 2014: a nationwide Danish cohort study

Pallisgaard, Jannik Langtved; Gislason, Gunnar; Hansen, Jim; Johannessen, Arne; Torp‐Pedersen, Christian; Rasmussen, Peter; Hansen, Morten Lock

doi:10.1093/eurheartj/ehx466

Cited by 102 publications

(79 citation statements)

References 20 publications

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“…However, real-world data from Denmark have been used to show reductions in AF-related clinical encounters after AF ablation from 2005 to 2014, suggesting secular improvements in AF ablation effectiveness. 19 In a contemporary and rigorous review of the literature, we did not detect any improvements in NPAF ablation efficacy over time. Importantly though, incremental gains in PAF procedural success appear to have occurred, with important caveats and implications.…”

Section: Discussionmentioning

confidence: 67%

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

Perino

Leef

Cluckey

et al. 2019

American Heart Journal

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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.

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Section: Discussionmentioning

confidence: 67%

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

Perino

Leef

Cluckey

et al. 2019

American Heart Journal

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“…Several predictors of mid-and long-term recurrence have been described. Some studies found a statistically significant independent association between AF history duration prior to radiofrequency ablation and recurrence after the procedure, [2][3][4][5] whereas this relationship has not been reported in other series. [6][7][8][9][10] Clarification of this issue might have important implications since there seem to be a tendency to postpone catheter ablation in patients with a short clinical history of AF.…”

Section: Introductionmentioning

confidence: 78%

Atrial fibrillation history impact on catheter ablation outcome. Findings from the ESC‐EHRA Atrial Fibrillation Ablation Long‐Term Registry

Stabile

Trines

Arbelo

et al. 2019

Pacing Clinical Electrophis

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Background: Atrial fibrillation (AF) promotes atrial remodeling that in turn promotes AF perpetuation. The aim of our study is to investigate the impact of AF history length on 1-year outcome of AF catheter ablation in a cohort of patients enrolled in the Atrial Fibrillation Ablation Registry. Methods:We described the real-life clinical epidemiology, therapeutic strategies, and the shortand mid-term outcomes of 1948 patients (71.9% with paroxysmal AF) undergoing AF ablation procedures, stratified according to AF history duration (<2 years or ≥2 years). Results:The mean AF history duration was 46.2 ± 57.4 months, 592 patients had an AF history duration <2 years (mean 10.2 ± 5.9 months), and 1356 patients ≥2 years (mean 75.5 ± 63.5 months) (P < 0.001). Patients with AF history duration <2 years were younger; had a lower incidence of hypertension, coronary artery disease, and hypertrophic cardiomyopathy; and had a lower CHA 2 DS 2 -VaSc Score. At 1 year, the logrank test showed a lower incidence of AF recurrence in patients with AF history duration <2 years (28.9%) than in patients with AF history duration ≥2 years (34.0%) (P = 0.037). AF history duration ≥2 years, overall ablation procedure duration, hypertension, and chronic kidney disease were all predictors of recurrences after the blanking period. Conclusions:In this multicenter registry, performing catheter ablation in patients with an AF history ≥2 years was associated with higher rates of AF recurrences at 1 year. Since cumulative time in AF in not necessarily equivalent to AF history, its role remains to be clarified. K E Y W O R D Satrial fibrillation, atrial fibrillation duration, catheter ablation, mid-term outcome, recurrence predictors

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“…The influence of age and hypertension did not reach statistical significance, while BMI was not reported. A recent Danish nationwide cohort study investigated the 1 year risk of AF recurrence following first time ablation in 5425 patients . Female sex (OR 1.20; 95% CI 1.06‐1.37) AF duration >2 years (OR 1.14; 95% CI 1.01‐1.28), hypertension (OR 1.23; 95% CI 1.09‐1.38) and cardioversion in the year prior to ablation (OR 1.40; 95% CI 1.17‐1.67) all predicted AF recurrence, while BMI was not reported.…”

Section: Discussionmentioning

confidence: 99%

Influence of risk factors in the ESC‐EHRA EORP atrial fibrillation ablation long‐term registry

Trines

Stabile

Arbelo

et al. 2019

Pacing Clinical Electrophis

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Background The influence of risk factors on atrial fibrillation (AF) ablation recurrence is increasingly recognized. We present a sub‐analysis of the European Society of Cardiology‐European Heart Rhythm Association‐European Society of Cardiology AF ablation long‐term registry on the effect of traditional risk factors for AF on postablation recurrence, reablation, and complications using real‐world data. Methods Risk factors for AF were defined as body mass index ≥27 kg/m², hypertension, chronic obstructive pulmonary disease, diabetes, alcohol ≥2 units/day, sleep apnea, smoking, no/occasional sports activity, moderate/severe mitral or aortic valve disease, any cardiomyopathy, peripheral vascular disease, chronic kidney disease, heart failure, coronary artery disease/infarction, and previous pacemaker/defibrillator implant. Patients were divided in two groups with ≥1 or without risk factors. Primary outcomes were arrhythmia recurrence after blanking period, reablation, and adverse events or death. Differences between the groups and the influence of individual risk factors were analyzed using multivariate Cox regression. Results Three thousand sixty nine patients were included; 217 patients were without risk factors. Risk factor patients were older (58.4 vs 54.1 years), more often female (32% vs 19.8%) and had more often persistent AF (27.2% vs 23.5%). In a multivariate analysis, patients without risk factors had a hazard ratio of 0.70 (95% CI 0.49‐0.99) for recurrence compared to risk factor patients. The multivariate hazard ratios for reablation or adverse events/death were not different between the two groups. Hypertension and body mass index were univariate predictors of recurrence. Conclusions Patients with ≥1 risk factor had a 30% higher risk for arrhythmia recurrence after ablation, but no differences in risk for repeat ablations and adverse events or death.

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Temporal trends in atrial fibrillation recurrence rates after ablation between 2005 and 2014: a nationwide Danish cohort study

Abstract: One year risk of recurrent AF following first-time ablation has almost halved from 2006 to 2014. Hypertension, female sex, cardioversion 1 year prior to ablation, and AF duration for more than 2 years all increased the associated risk of recurrent AF.

Cited by 102 publications

References 20 publications

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

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

Atrial fibrillation history impact on catheter ablation outcome. Findings from the ESC‐EHRA Atrial Fibrillation Ablation Long‐Term Registry

Influence of risk factors in the ESC‐EHRA EORP atrial fibrillation ablation long‐term registry

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