07-12-2009 - Up-dated Worldwide Survey on the Methods, Efficacy and Safety of Catheter Ablation for Human Atrial Fibrillation.
Circ Arrhythm Electrophysiol. 2009 Dec 7; [EPub ahead of print]
PMID: 19995881 [PubMed - as supplied by publisher]
Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, Skanes A, Ambrogi F, Biganzoli E.
IRCCS, Policlinico San Donato, Milan, Italy
BACKGROUND: -The purpose of this study was to provide an up-dated worldwide report on the methods, efficacy and safety of catheter ablation (CA) of atrial fibrillation (AF). METHODS AND RESULTS: -A questionnaire with 46 questions was sent to 521 centers from 24 countries in 4 continents. Complete interviews were collected from 182 centers, of which 85 reported to have performed 20,825 CA procedures on 16,309 patients with AF between 2003 and 2006. The median number of procedures per center was 245 (range, 2 - 2,715). All centers included paroxysmal AF, 85.9% included also persistent and 47.1% included also long-lasting AF. Carto-guided left atrial circumferential ablation (48.2% of patients) and Lasso-guided ostial electrical disconnection (27.4%) were the most commonly used techniques. Efficacy data were analyzed with centers representing the unit of analysis. Of 16,309 patients with full disclosure of outcome data, 10,488 (median 70.0%; interquartile range 57,7% - 75.4%) became asymptomatic without anti-arrhythmic drugs (AADs) and another 2,047 (10.0%; 0.5% - 17.1%) became asymptomatic in the presence of previously ineffective AADs over 18 (range, 3 - 24) months follow up. Success rates free of AADs and overall success rates were significantly larger in 9,590 patients with paroxysmal AF (74.9% and 83.2%) than in 2,800 patients with persistent AF (64.8% and 75.0%) and 1,108 patients with long-lasting AF (63.1% and 72.3%) (p < 0.0001). Major complications were reported in 741 patients (4.5%). CONCLUSIONS: -When analyzed in a large number of EP laboratories worldwide, CA of AF shows to be effective in about 80% of patients after 1.3 procedures / patient, with about 70% of them not requiring further AADs during intermediate follow-up.
