Procedural, technological changes improving first-time AF ablation outcomes
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Improved atrial fibrillation ablation strategies and technologies during the past decade are associated with a stepwise reduction in the rate of redo AF procedures, increased procedural volume and shortened procedure times, data show.
In an analysis of AF ablation procedures performed between 2011 and 2021, researchers found that first-time AF ablation volumes increased by 135%, the rate of patients undergoing redo AF procedures or direct current cardioversion within 3 years fell by 36% and mean procedure time decreased by 50%, whereas the rate of adverse events remained constant.
“Atrial fibrillation ablation procedures have become more effective and shorter thanks to advances in technology and ablation practices despite patients being older with more comorbidities,” Alexander Kushnir, MD, PhD, assistant clinical professor in the Leon H. Charney Division of Cardiology at NYU Langone Health, told Healio. “More patients and clinicians can consider AF ablation as a first-line option for symptomatic AF.”
Kushnir and colleagues analyzed data from patients who presented to NYU Langone Health between 2011 and 2021 for a first-time AF ablation. Researchers assessed time to redo AF ablation or direct current cardioversion for recurrent AF during a 3-year follow-up period and how procedures correlated with ablation technology and practices, antiarrhythmic medications and patient comorbid conditions.
The findings were published in the Journal of Cardiovascular Electrophysiology.
From 2011 to 2021, the cardiac electrophysiology lab adopted irrigated-contact force ablation catheters, high-power short duration ablation lesions, steady-pacing and jet ventilation, and eliminated stepwise linear ablation for AF ablation.
During this time, the number of first-time AF ablations increased from 403 to 1,074; however, the percentage of patients requiring repeat AF-related intervention within 3 years of the index procedure dropped from 22% to 14%. Additionally, the mean procedure time decreased from 271 minutes to 135 minutes. The mean annual major adverse event rate remained constant at 1.1%.
Patient comorbid conditions increased during this period, and antiarrhythmic drug did not change during the period, according to researchers.
The researchers noted that AF ablation volume growth during the study period can be attributed to increased incidence of AF in the patient population and/or improved procedural efficiency from physician experience and technologic advancements. The reduction in redo AF procedures along with shorter procedure times and a relatively low procedural risk may have also influenced general cardiologists to refer more patients for an AF ablation procedure, they wrote.
“Detailed analyses of ablation procedures are needed to determine what areas of the heart should be ablated for each patient,” Kushnir told Healio.
For more information:
Alexander Kushnir, MD, PhD, can be reached at alexander.kushnir@nyulangone.org; Twitter: @alexk_ep.
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