Success Rate of AF Ablation Without Antiarrhythmic Drugs Is 40% in Europe

February 20, 2014

BARCELONA, SPAIN — A European pilot study of patients with atrial fibrillation (AF) undergoing catheter ablation reveals that just over 40% of patients are free from AF at one year without the use of antiarrhythmic medications[1]. AF patients with paroxysmal AF had higher success rates than those with persistent or long-lasting persistent AF, according to the authors of the new report.

The data in the report, published January 31, 2014 in the European Heart Journal, are taken from the Euro-Observational Research Program (EORP) AF Ablation Pilot Study conducted by the European Heart Rhythm Association (EHRA). Led by Dr Elena Arbelo (University of Barcelona, Spain), the pilot study is part of a prospective registry that assesses the clinical characteristics of AF patients undergoing ablation and the diagnostic procedures and treatments they receive while undergoing ablation at centers throughout Europe.

In the pilot study, 1391 patients underwent AF ablation at 72 medium- to high-volume centers in 10 European countries. Each hospital enrolled 20 consecutive patients undergoing a first AF catheter-ablation procedure, and clinical outcomes were assessed at one year.

Regarding treatment success, 73.7% had no documented arrhythmia from the three-month blanking period until the end of follow-up at 12 months. In total, 40.7% were successfully treated with ablation and free from antiarrhythmic medication at one year, although, as the researchers point out, the protocol did not require physicians to stop antiarrhythmic drug therapy after the blanking period. Success rates were highest in the paroxysmal-AF patients (43.7%) and lowest in those with persistent AF (30.2%). A second ablation was performed in 18.3% of patients, and 43.4% were still taking antiarrhythmic medication at 12 months.

At one year, 65% of patients were taking some type of anticoagulant medication. Among those at highest risk from thrombosis, those with a CHADS2-Vasc score >1, just 76.2% were taking an oral anticoagulant. By contrast, roughly half of the patients at low cardioembolic risk (CHADS2-Vasc 0) were still taking anticoagulation. "These figures document how difficult it is to implement simple guidelines in everyday clinical practice, even in expert centers performing catheter ablation of AF," write Arbelo and colleagues.

Adverse events occurred in 2.5% of the treated patients, and four patients died, including one patient from hemorrhagic stroke. Regarding the adverse events, there were 13 pacemaker implantations, nine vascular injuries, seven cerebrovascular injuries, two phrenic-nerve injuries, and one case of pulmonary vein stenosis. In the 12-month follow-up, left atrial tachycardia, including atrial flutter, was reported in one out of every five patients. Complication rates, say the researchers, were similar to rates observed in other multicenter surveys but slightly higher than those reported from single centers.

The authors reports no conflicts of interest.

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