scholarly journals Impact of centre volume on atrial fibrillation ablation outcomes in Europe: a report from the ESC EHRA EORP Atrial Fibrillation Ablation Long-Term (AFA LT) Registry

EP Europace ◽  
2020 ◽  
Author(s):  
Vassilios P Vassilikos ◽  
Efstathios D Pagourelias ◽  
Cécile Laroche ◽  
Carina Blomström-Lundqvist ◽  
Josef Kautzner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Success Rate ◽  
Cardiovascular Complications ◽  
Atrial Fibrillation Ablation ◽  
Complication Rates ◽  
Stroke Incidence ◽  
Af Ablation ◽  
Long Term Study ◽  
Low Volume

Abstract Aims  The aim of the study was to investigate differences in clinical outcomes and complication rates among European atrial fibrillation (AF) ablation centres related to the volume of AF ablations performed. Methods and results  Data for this analysis were extracted from the ESC EHRA EORP European AF Ablation Long-Term Study Registry. Based on 33rd and 67th percentiles of number of AF ablations performed, the participating centres were classified into high volume (HV) (≥ 180 procedures/year), medium volume (MV) (<180 and ≥74/year), and low volume (LV) (<74/year). A total of 91 centres in 26 European countries enrolled in 3368 patients. There was a significantly higher reporting of cardiovascular complications and stroke incidence in LV centres compared with HV and MV (P = 0.039 and 0.008, respectively) and a lower success rate after AF ablation (55.3% in HV vs. 57.2% in LV vs. 67.4% in MV centres, P < 0.001), despite lower CHA2DS2-VASc score of patients, enrolled in LVs and less complex ablation techniques used. Adjustments of confounding factors (including type of AF ablation) led to elimination of these differences. Conclusion  Low-volume centres tended to present slightly higher cardiovascular complications’ and stroke incidence and a lower unadjusted success rate after AF ablation, despite the fact that ablation procedures and patients were of lower risk compared with MV and HV centres. On the other hand, adjusted overall complication and recurrence rates were non-significantly different among different volume centres, a fact reflecting the heterogeneity of patient and procedural profiles, and a counterbalance between expertise and risk level among participating centres.

scholarly journals Impact of procedural volume on complication and recurrence rate after atrial fibrillation ablation in European centers. An ESC EORP Registry: Atrial Fibrillation Long-Term

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Pagourelias ◽  
V Vassilikos ◽  
C Blomstrom-Lundqvist ◽  
J Kautzner ◽  
A.P Maggioni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Success Rate ◽  
Cardiovascular Complications ◽  
Recurrence Rates ◽  
Stroke Incidence ◽  
Af Ablation ◽  
Procedural Volume ◽  
Low Volume ◽  
One Year

Abstract Background Catheter ablation has emerged as an effective therapy in patients with atrial fibrillation (AF). Despite high success rates of the method, there is still heterogeneity of outcomes and complications across Europe. A center's volume of AF ablations performed per year might also play an important role in the success rate of the procedure as compared to other confounding factors which may be different among centers (such as type of AF ablated, patient selection criteria, referral bias and/or ablation strategy). Purpose Aim of the study was to investigate differences in clinical outcomes and complication rates among European AF ablation centers related to the volume of ablations performed annually. Methods Data for this analysis were extracted from the European AF Ablation Long-Term Study, a prospective registry designed to describe the clinical epidemiology of patients undergoing AF ablation. Based on 33th and 67th percentiles of number of AF ablations performed, the participating centers were classified into high volume (HV) (≥180 procedures/year), medium volume (MV) (<180 and ≥74/year) and low volume (LV) (<74/year). One-year success was defined as patient survival free from any atrial arrhythmia, from the end of the 3-month blanking period to 12 months following the ablation procedure. Results A total of 91 centers in 26 European countries enrolled 3368 patients. There was a significantly higher reporting of cardiovascular complications in LV centers (5.2%), especially pericarditis and cardiac perforation, while the HV and MV centers reported cardiovascular complications in 3.0 and 4.3% of cases, respectively (p=0.039). Additionally, stroke incidence after ablation was significantly higher in LV centers (0.5% of cases vs 0% in HV and MV centers, p=0.008). One-year success after AF ablation ranged from 77.8% in HV vs 70.5% in LV vs 77.3% in MV centers (p<0.001). Despite these unadjusted differences, Kaplan-Meier survival analysis based on adjusted data demonstrated, however, that there were not significant differences in complication and recurrence rates according to volume's center (p=0.328 and p=0.476 accordingly, Figure A). This result was mainly driven by a proportional increase in severity/risk of cases ablated (as evidenced by CHA2DS2-VASc score and AF type) in relation to a center's procedural volume (Figure B). Conclusions Low volume centers present slightly higher cardiovascular complications' and stroke incidence and a lower unadjusted success rate after AF ablation. On the other hand, adjusted overall complication and recurrence rates are non-significantly different among different volume centers, a fact reflecting inhomogeneity of patient and procedural profiles and a counterbalance between expertise and risk level among participating centers. Funding Acknowledgement Type of funding source: None

scholarly journals Catheter-related complications and mortality of atrial fibrillation ablation following introduction of contact force-sensing technology

2020 ◽  
Vol 2 (1) ◽  
pp. e000058
Author(s):  
Joseph G Akar ◽  
James P Hummel ◽  
Xiaoxi Yao ◽  
Lindsey Sangaralingham ◽  
Sanket Dhruva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Care ◽  
Contact Force ◽  
Emergency Department Visits ◽  
Atrial Fibrillation Ablation ◽  
Esophageal Injury ◽  
Force Sensing ◽  
Complication Rates ◽  
Af Ablation ◽  
Complications And Mortality

ObjectivesContact force-sensing catheters allow real-time catheter-tissue contact force monitoring during atrial fibrillation. These catheters were rapidly adopted into clinical practice following market introduction in 2014, but concerns have been raised regarding collateral damage such as esophageal injury. We sought to examine whether the introduction of force-sensing catheters was associated with a change in short-term and intermediate-term acute care use, complications and mortality following atrial fibrillation ablation.DesignRetrospective cohort analysis. We used inverse probability treatment weight matching to account for the differences in baseline characteristics between groups.SettingWe examined patients included in the OptumLabs Data Warehouse who underwent ablation for atrial fibrillation before (2011–2013) and after (2015–2017) the market introduction of contact force-sensing catheters.Main outcome measuresWe examined 30-day and 90-day rates of all-cause acute care use, including hospitalizations and emergency department visits, as well as death and hospitalization for catheter-related complications, including atrioesophageal fistula, pericarditis, cardiac tamponade/perforation and stroke/transient ischemic attack.ResultsOur sample included 3470 and 5772 patients who underwent atrial fibrillation (AF) ablation before and after market introduction of contact force-sensing catheters, respectively. Complication rates were low and did not differ between the two periods (p>0.10 for each outcome). The 30-day and 90-day mortality was 0.1% and 0.3%, respectively after market introduction and unchanged from prior to 2014. The 90-day rates of all-cause acute care use decreased, from 27.0% in 2011–2013 to 23.9% in 2015–2017 (p<0.001).ConclusionsAF ablation-related catheter complications and mortality are low and there has been no significant change following the introduction of force-sensing catheters.

scholarly journals Impact of monitoring on detection of arrhythmia recurrences in the ESC-EHRA EORP atrial fibrillation ablation long-term registry

EP Europace ◽  
2019 ◽  
Vol 21 (12) ◽  
pp. 1802-1808
Author(s):  
Tosho Balabanski ◽  
Josep Brugada ◽  
Elena Arbelo ◽  
Cécile Laroche ◽  
Aldo Maggioni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Fibrillation Ablation ◽  
Rank Test ◽  
Lower Probability ◽  
Monitoring Methods ◽  
Holter Ecg ◽  
Af Ablation ◽  
Log Rank Test

Abstract Aims Monitoring of patients after ablation had wide variations in the ESC-EHRA atrial fibrillation ablation long-term (AFA-LT) registry. We aimed to compare four different monitoring strategies after catheter AF ablation. Methods and results The ESC-EHRA AFA-LT registry included 3593 patients who underwent ablation. Arrhythmia monitoring during follow-up was performed by 12-lead electrocardiogram (ECG), Holter ECG, trans-telephonic ECG monitoring (TTMON), or an implanted cardiac monitoring (ICM) system. Patients were selected to a given monitoring group according to the most extensive ECG tool used in each of them. Comparison of the probability of freedom from recurrences was performed by censored log-rank test and presented by Kaplan–Meier curves. The rhythm monitoring methods were used among 2658 patients: ECG (N = 578), Holter ECG (N = 1874), TTMON (N = 101), and ICM (N = 105). A total of 767 of 2658 patients (28.9%) had AF recurrences during follow-up. Censored log-rank test discovered a lower probability of freedom from relapses, which was detected with ICM compared to TTMON, ECG, and Holter ECG (P < 0.001). The rate of freedom from AF recurrences was 50.5% among patients using the ICM while it was 65.4%, 70.6%, and 72.8% using the TTMON, ECG, and Holter ECG, respectively. Conclusion Comparing all main electrocardiographic monitoring methods in a large patient sample, our results suggest that post-ablation recurrences of AF are significantly underreported by TTMON, ECG, and Holter ECG. The ICM estimates AF ablation recurrences most reliably and should be a preferred mode of monitoring for trials evaluating novel AF ablation techniques.

P4762What do atrial fibrillation ablation procedural volume differences across European centers reflect? An ESC EORP registry: atrial fibrillation long-term

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Pagourelias ◽  
V Vassilikos ◽  
C Blomstrom-Lundqvist ◽  
J Kautzner ◽  
A P Maggioni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Epidemiology ◽  
Regional Distribution ◽  
High Volume ◽  
Af Ablation ◽  
Ablation Volume ◽  
Long Term Study ◽  
Procedural Volume ◽  
Risk Patients

Abstract Background Data from the European Atrial Fibrillation (AF) Ablation Long-Term Registry suggest that there are significant differences in the volume of AF ablation procedures performed across different centers even in the same country. If these differences in AF ablation volume between centers reflect regional, socioeconomic, infrastructural/technical or other disparities has not been addressed till now. Purpose The aim of this study was to investigate patient and non-patient related differences among European AF ablation centers according to the volume of AF ablations performed. Methods Data for this analysis originate from the European AF Ablation Long-Term Study, a prospective registry designed to describe the clinical epidemiology of patients undergoing AF ablation. Based on 25th and 75th percentiles of AF ablation numbers performed, the participating centers were classified into high volume (HV) (≥250 procedures/year), medium volume (MV) (<250 and ≥58/year) and low volume (LV) (<58/year). Patient (demographics, comorbidities) and non-patient (center infrastructure, procedural characteristics) related differences were assessed. Results A total of 91 centers in 26 European countries enrolled 3368 patients. There were no significant differences concerning regional distribution, hospital/cardiology facilities or services provided among centers with the exception of electrophysiology procedures and labs which were more abundant in HV centers (p=0.02 and <0.001 respectively). HV and MV centers ablate twice more cases of long-standing persistent and persistent AF compared to LV centers, in which paroxysmal AF reaches 78.9% of all cases (Figure A). Accordingly, first AF ablation procedure was far more frequent in LV centers compared to MV and HV (85.8% vs 76.0% vs 76.1% respectively, p<0.001). Even though HV centers ablate significantly more high risk patients (CHA2DS2-VASc score ≥2 51.4% in HV vs 46.5% in MV vs 37.2% in LV, p<0.001) (Figure B) with accompanying comorbidities, applying more elaborate ablation techniques, fluoroscopy time and radiation dose were higher among patients undergoing AF ablation in LV centers (p<0.001 for all). Despite the above-mentioned dissimilarities, Kaplan-Meier survival analysis, based on adjusted data, demonstrated non-significant differences in complication rate (p=0.402) or AF recurrence rate (p=0.363) among HV, MV and LV centers. Conclusions Volume of AF ablations in a center is not correlated with regional or infrastructural characteristics. The higher volume in HV centers consists mainly by more long-term persistent AF and higher risk patients, suggesting that differences in volume reflect differences in experience and personnel's commitment towards AF ablation.

P1028Impact of atrial fibrillation ablation procedural volume on complication and recurrence rate across European centers. An ESC EORP registry: atrial fibrillation long-term

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Pagourelias ◽  
V Vassilikos ◽  
C Blomstrom-Lundqvist ◽  
J Kautzner ◽  
A P Maggioni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Recurrence Rate ◽  
Complication Rate ◽  
Cardiovascular Complications ◽  
Safe Procedure ◽  
Success Rates ◽  
Af Ablation ◽  
Procedural Volume ◽  
One Year

Abstract Background Catheter ablation has emerged as an effective therapy in patients with symptomatic and drug refractory atrial fibrillation (AF). Despite high success rates of the method, there is still heterogeneity of outcomes and complication rate across Europe. The impact of the annual procedural volume per center on success and complication rate of AF ablation, based on real-life data, has not been addressed till now. Purpose The aim of the study was to investigate if center AF ablation volume might be associated with one-year success or complication rate after the procedure. Methods Data for this analysis were extracted from the European AF Ablation Long-Term Study, a prospective registry designed to describe the clinical epidemiology of patients undergoing AF ablation. Based on 25th and 75th percentiles of AF ablation numbers performed, the participating centers were classified into high volume (HV) (≥250 procedures/year), medium volume (MV) (<250 and ≥58/year) and low volume (LV) (<58/year). One-year success was defined as patient survival free from any atrial arrhythmia, from the end of the 3-month blanking period to 12 months following the ablation procedure. Results A total of 91 centers in 26 European countries enrolled 3368 patients. There was a significantly higher reporting of cardiovascular complications in LV centers (5.2%), especially pericarditis (0.6%) and cardiac perforation (1.4%), while the HV and MV centers reported cardiovascular complications in 3.0 and 4.3% of cases, respectively (p=0.039). Additionally, stroke incidence after ablation was significantly higher in LV centers (0.5% of cases vs 0% in HV and MV centers, p=0.008). Kaplan-Meier survival analysis based on adjusted data of all complications demonstrated, however, that there was not a significant difference in complication rate according to volume's center (p=0.402, Figure A). One-year success after AF ablation ranged from 77.8% in HV vs 70.5% in LV vs 77.3% in MV centers (p<0.001). Nonetheless, adjusted recurrence rate was not significantly different among centers (p=0.363, Figure B), a result driven by differences both in ablation technical characteristics and risk/severity of cases ablated in different volume centers. Conclusions Despite the notion that “the higher, the better”, our results suggest that AF ablation is a safe procedure with high success rates in all European centers, independent of the AF ablation procedural volume. Differences in patients and procedural characteristics may justify the equality of complication and recurrence rate among centers, since expertise level counterbalances the risk of each case.

scholarly journals In-hospital and 12-month follow-up outcome from the ESC-EORP EHRA Atrial Fibrillation Ablation Long-Term registry: sex differences

EP Europace ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 66-73 ◽  
Author(s):  
Mihaela Grecu ◽  
Carina Blomström-Lundqvist ◽  
Josef Kautzner ◽  
Cecile Laroche ◽  
Isabelle C Van Gelder ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sex Differences ◽  
Research Programme ◽  
Heart Rhythm ◽  
Neurological Complications ◽  
Cardiovascular Complications ◽  
Atrial Fibrillation Ablation ◽  
Improved Outcomes ◽  
Diabetes And Obesity

Abstract Aim The purpose of this study was to compare sex differences of atrial fibrillation (AF) catheter ablation (CA) and to analyse the opportunities for improved outcomes. Methods and results All data were collected from the Atrial Fibrillation Ablation Long-Term registry, a prospective, multinational study conducted by the ESC-EORP European Heart Rhythm Association (EHRA) under the EURObservational Research Programme (ESC-EORP). A total of 104 centres in 27 European countries participated. Of 3593 included patients, 1146 (31.9%) were female. Female patients were older (61.0 vs. 56.4 years; P &lt; 0.001), had more comorbidities (hypertension, diabetes, and obesity), more episodes of arrhythmias per month (6.9 vs. 6.2; P &lt; 0.001), and a higher average EHRA score (2.6 vs. 2.4; P &lt; 0.001). The duration of the procedure was shorter in females (160.1 min vs. 167.9 min; P &lt; 0.001), irrespective of additional ablation lesions added to pulmonary vein isolation. Overall cardiovascular complications were more frequent in women than in men (5.7% vs. 3.4%; P &lt; 0.001). Furthermore, cardiac perforations (3.8% vs. 1.3%; P = 0.011) and neurological complications (2.2% vs. 0.3%; P = 0.004) were found in females in less experienced centres than in experienced ones. On a final note, at 12 months, AF recurrence rate was similar in females and males (34.4% vs. 34.2%; P = 0.897), but more females were still on antiarrhythmic drugs (50.6% vs. 44.1%; P &lt; 0.001) when compared with men. Conclusion Females underwent CA procedures for AF less frequently than males throughout Europe, despite more recurrent symptoms. With the same success rate, severe acute complications remained considerable in females, especially in less experienced centres.

scholarly journals Which patients with atrial fibrillation undergo an ablation procedure today in Europe? A report from the ESC-EHRA-EORP Atrial Fibrillation Ablation Long-Term and Atrial Fibrillation General Pilot Registries

EP Europace ◽  
2019 ◽  
Vol 22 (2) ◽  
pp. 250-258 ◽  
Author(s):  
Roland Richard Tilz ◽  
Nikolaos Dagres ◽  
Elena Arbelo ◽  
Carina Blomström-Lundqvist ◽  
Harry J Crijns ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rhythm ◽  
Left Ventricular ◽  
Atrial Fibrillation Ablation ◽  
Left Ventricular Ejection ◽  
Web Based ◽  
Ventricular Ejection Fraction ◽  
Af Ablation ◽  
Atrial Size

Abstract Aims Rhythm control management in patients with atrial fibrillation (AF) may be unequal across Europe. The aim of this study was to investigate how selective the patient cohort referred for AF ablation is, as compared to the general AF population in Europe, and to describe the governing mechanisms for such selection. Methods and results Descriptive comparative statistical analyses of the baseline characteristics were performed between the cohorts of Atrial Fibrillation Ablation Long-Term (ESC EORP AFA-LT) registry, designed to provide a picture of contemporary real-world AF ablation, and the AF population from the AF-General (ESC EORP AF-Gen) pilot registry. Data collection was performed using a web-based system. In the AFA and in the Atrial Fibrillation General (AFG) pilot registries, 3593 and 3049 patients were enrolled, respectively. Patients who underwent AF ablation were younger, more commonly male, and had significantly less comorbidities. Atrial Fibrillation Ablation patients often presented without comorbidities, resulting in a lower risk of stroke (CHA2DS2-VASc ≥5: 2.9% vs. 24.5%, all P &lt; 0.001) and bleeding (HAS-BLED ≥2: 8.5% vs. 40.5%, P &lt; 0.001) but with European Heart Rhythm Association (EHRA) scores &gt;1 and more prevalent AF-related symptoms such as palpitations, fatigue, and weakness (all P &lt; 0.001) as compared to the general AF patients. Atrial Fibrillation Ablation patients were significantly more often male, had higher left ventricular ejection fraction (59.5% vs. 52.4%) and smaller left atrial size on echocardiogram (P &lt; 0.001 each). Conclusion The comparison of the patient cohorts in the AFA and AFG registries showed that AF ablation in European clinical practice is mostly performed in relatively young, symptomatic and relatively healthy patients.

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