Catheter ablation for AF showed promising 1-year results

Issue: November 2012

MUNICH — One-year data from the Atrial Fibrillation Ablation Pilot Study demonstrate that catheter ablation for atrial fibrillation is safe and suppresses arrhythmia recurrence in 74% of patients after a single procedure.

Additionally, catheter ablation for AF was associated with a significant reduction at 1 year in arrhythmia-related symptoms such as palpitations, shortness of breath, fatigue or dizziness that were present in 86% of patients before the procedure.

The prospective, multicenter, observational Atrial Fibrillation Ablation Pilot Study is the first European registry to evaluate the real-life epidemiology of catheter ablation for AF, according to a press release. Researchers recruited 1,410 patients from 10 European countries. Results from the in-hospital phase of the study were presented at the European Society of Cardiology 2011 Congress, showing that two-thirds of patients having catheter ablation have paroxysmal AF and up to 40% have no apparent underlying cardiac disorder.

Elena Arbelo

Elena Arbelo, MD, of the Hospital Clinic de Barcelona, presented results from the 1-year follow-up visit at this year’s Congress.

At a press conference, Arbelo said 77% of patients visited the clinic in person for review; however, at 1 year, 42% of evaluations were conducted by telephone.

In other results:

More than half of patients became asymptomatic after the ablation procedure.
Seventy-six percent of patients had a periodical ECG to document arrhythmia recurrence, and only half of patients had Holter monitoring.
One-third of patients had a transthoracic echocardiogram during follow-up; cardiac CT or MRI tests were rare.
About 20% of patients required a second ablation procedure.
At 1 year, about half of patients were taking anticoagulants and 32% were taking antiarrhythmic drugs. At discharge, 97% of patients had been prescribed anticoagulants and 67% had been prescribed antiarrhythmic medications.
Ablation was considered successful in 74% of patients, who had no documented arrhythmias after a 3-month blanking period.

Complications during the first year of follow-up were infrequent and occurred in just 2.6% of patients. Adverse events were mainly related to cerebrovascular events (0.54%) or vascular injuries (071%). Four deaths occurred; one secondary to hemorrhagic stroke, one following ischemic ventricular fibrillation, one to a non-CV cause and one of unknown origin, according to the press release.

“However, the perioperative complication rate is not negligible — 7.7%; 1.7% was major — and must be weighed,” Arbelo said during a press conference.

The mean age of the patients included in the study was 60 years; 28% were women; two-thirds had paroxysmal AF and 38% had lone AF.

“There are obvious differences in patient characteristics between patients undergoing AF catheter ablation to the overall population suffering from AF — they are younger with paroxysmal AF with no underlying heart disease and [are mostly] women,” Arbelo said.

The researchers concluded that the 1-year pilot study data provide “crucial information on AF ablation in clinical practice across Europe.”

“(However), there is clearly a gap between recommendations and the actual clinical practice that should be considered in the future, including anticoagulation and antiarrhytmic medication management and type and frequency of follow-up,” Arbelo said.

For more information:

Arbelo E. Hot line III: Late breaking trials on arrhythmias and CAD. Presented at: the European Society of Cardiology Congress; Aug. 25-29, 2012; Munich.

Arbelo E. Europace. 2012;14:1094-1103.

Disclosure: Arbelo reports no relevant financial disclosures.