Key result
Despite significant decreases in procedure times, fluoroscopy times, and total complications from 2003 to 2010, post-ablation freedom from atrial fibrillation has not improved commensurately.
Why the study?
How have patient characteristics, procedural variables, complications, and outcomes of atrial fibrillation ablation evolved over time?
Observational (n=1,125)
No
How have patient characteristics, procedural variables, complications, and outcomes of atrial fibrillation ablation evolved over time?
Despite significant reductions in procedure times and complication rates over a 7-year period, AF ablation efficacy has plateaued, suggesting a need for personalized approaches based on a better understanding of AF mechanisms.
AF ablation efficacy has plateaued despite procedural gains; hypothesis-generating for mechanism-targeted personalization in future studies.
PURPOSE: The purpose of this study was to evaluate how atrial fibrillation (AF) ablation has evolved over time with regards to patient characteristics, procedural variables, complications, and outcomes. METHODS: We evaluated trends over time from 2003 to 2010 in clinical characteristics, procedural variables, complications, and Kaplan-Meier AF-free rates after the initial and final AF ablation in 1,125 patients undergoing 1,504 ablations. RESULTS: Evaluating trends from 2003 to 2010, we found that patients undergoing AF ablation became older (P < 0.0001), had higher CHADS(2) scores (P < 0.0001), and more coronary artery disease (P = 0.021), persistent AF (P < 0.0001), hypertension (P < 0.0001), and previous strokes/transient ischemic attacks (P = 0.005). Procedure times decreased from 256 ± 49 to 122 ± 28 min (P < 0.0005), fluoroscopy times decreased from 134 ± 29 to 56 ± 19 min (P < 0.0005), and major (P = 0.023), minor (P = 0.023), and total complications (P = 0.001) decreased over time. The learning curve to minimize complications was 6 years. For paroxysmal AF, initial ablation AF-free rates improved over time (P = 0.015) but improvement plateaued in recent years. For persistent AF, initial ablation AF-free rates trended toward improvement over time (P = 0.062) but also plateaued in recent years. For long-standing persistent AF (P = 0.995), there was no outcome improvement after initial ablation over time. There was no trend for improved final outcomes (including repeat ablations) over time for paroxysmal, persistent, or long-standing AF (P = 0.150 to P = 0.978). CONCLUSIONS: Despite decreased procedural and fluoroscopy times and reduced complication rates, post-ablation freedom from AF has not improved commensurately in recent years. A better understanding of AF initiation and maintenance may be required to devise personalized approaches to AF ablation and further improve outcomes.
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Winkle et al. (2012) conducted an observational in Atrial Fibrillation (n=1,125). Atrial fibrillation ablation vs. Temporal trends (2003-2010) was evaluated on Trends in Kaplan-Meier AF-free rates after initial and final AF ablation. Despite significant decreases in procedure times, fluoroscopy times, and total complications from 2003 to 2010, post-ablation freedom from atrial fibrillation has not improved commensurately.
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